腹腔镜双侧子宫动脉阻断术结合清宫术治疗子宫瘢痕妊娠

Laparoscopic Uterine Arteries Ligation Combined with Uterine Curettage in Treatment of Cesarean Scar Pregnancy

目的:探讨腹腔镜双侧子宫动脉阻断术结合清宫术治疗子宫瘢痕妊娠(cesarean scar pregnancy,CSP)的临床疗效。方法:回顾性分析2011年1月—2014年1月就诊于保定市第一中心医院的剖宫产术后CSP的60例患者临床资料,将其按治疗方法分为介入组和腹腔镜组,其中介入组(30例)患者先行介入子宫动脉栓塞术,再行超声引导下清宫术,腹腔镜组(30例)患者行腹腔镜双侧子宫动脉阻断术后再行清宫术,比较2组人绒毛膜促性腺激素(h CG)下降至正常的时间、术中出血量、术后不良反应发生率等。结果:2组手术时间,术后月经复潮时间比较差异无统计学意义(P>0.05),而腹腔镜组术中出血量、血h CG下降至正常的时间和总住院费用均低于介入组,差异均有统计学意义(P<0.05)。腹腔镜组腹痛、高热和白细胞升高的发生率均低于介入组,差异有统计学意义(P<0.05),而2组恶心、呕吐等消化道反应的发生率差异无统计学意义(P>0.05)。结论:腹腔镜双侧子宫动脉阻断术结合清宫术治疗剖宫产术后CSP,治疗效果满意、安全有效,是一种较理想的治疗方法。

Objective： To discuss the treatment of cesarean scar pregnancy （CSP） by the laparoscopic uterine arteries ligation combined with uterine curetlage. Methods：Sixty cases with CSP were retrospectively analyzed from January 2011 to January 2014 in our hospital. The cases were divided into two groups depending on different treatments： patients in the interventional therapy group （n=30）accepted bilateral uterine artery embolization,patients in the laparoscopic operation group （n=30）were treated by laparoscopy. When the uterine arteries were blocked by interventional or laparoscopic method,the uterine curettage under ultrasonic guidance was completed. The curative effects were compared, including the length of time of hCG descending to normal ,the intraoperative bleeding volume and the postoperative adverse reaction. Results：There were not significant differences in the operative time and the postoperative period of menses return between two groups （P〉0.05）. The blood loss,the time of hCG restored to normal range and the total hospital costs in the laparoscopic operation group were significantly lower than those in the interventional therapy group （P〈0.05）. The incidences of abdominal pain,fever and leukocytosis in the laparoscopic operation group were also significantly lower （P〈0.05）. However, there were not significant differences in the incidences of nausea, vomiting and other gastrointestinal reactions between the two groups （P〉0.05）. Conclusions：The laparoscopic uterine arteries ligation combined with uterine curettage is one of good treatments of CSP with its safety and efficiency.