腹腔镜下子宫双侧动脉阻断术联合清宫术治疗剖宫产瘢痕妊娠疗效分析

Effect of laparoscopic bilateral uterine artery occlusion combined with curettage on treatment of cesarean scar pregnancy

目的探讨腹腔镜下子宫双侧动脉阻断术联合清宫术治疗剖宫产瘢痕妊娠疗效及对内分泌的影响。方法选择2011年1月至2015年12月剖宫产瘢痕妊娠患者57例,其中A组32例患者给予超声引导下清宫术治疗,B组25例患者给予腹腔镜下子宫双侧动脉阻断术联合清宫术治疗,比较两组患者出血量、住院时间、月经复潮时间、术后人绒毛膜促性腺激素（h CG）降至正常时间,并发症情况及术前（T0）、术后第1d（T1）、第3d（T2）神经内分泌激素水平。结果 1B组患者出血量低于A组,住院时间、月经复潮时间短于A组,比较差异有统计学意义（t_（出血量）=31.85,t_（住院时间）=9.36,t_（月经复潮时间）=16.37,均P〈0.05）;2B组患者并发症发生率为8.00%,低于A组的15.63%,比较差异有统计学意义（χ~2=9.35,P〈0.05）;3B组T1、T2血清COR、β-EP、GLU水平低于A组（CORF交互=17.67,β-EPF交互=132.36,GLUF交互=155.38,均P〈0.05）。结论腹腔镜下子宫双侧动脉阻断术联合清宫术治疗剖宫产瘢痕妊娠微创优势明显,安全性高,对内分泌影响较轻。

Objective To investigate the effect of laparoscopic bilateral uterine artery occlusion combined with curettage on treatment of cesarean scar pregnancy（ CSP） and its influence on endocrine. Methods Fifty-seven patients with CSP from January 2011 to December2015 were selected,among which group A of 32 patients were treated with ultrasound-guided curettage treatment and group B of 25 patients were given laparoscopic bilateral uterine artery occlusion combining curettage treatment. Two groups were compared in blood loss,hospital stay,menstruation resume,time for postoperative human chorionic gonadotropin（ h CG） level down to normal level,complication status and neuroendocrine hormone level in preoperative day（ T0）,first postoperative day（ T1） and third postoperative day（ T2）. Results Compared to cases in group A,patients in group B had less bleeding amount,shorter hospital stay and earlier menstrual recovery with statistical significant differences（ t value was 31. 85,9. 36 and 16. 37,respectively,all P 〈0. 05）. Incidence of complication of group B was 8. 00%,which was lower than 15. 63% of group A,and the difference was statistically significant（ χ2= 9. 35,P 〈0. 05）. Serum COR,β-EP and GLU level in T1 and T2 of group B were lower than those of group A（ F value was 17. 67,132. 36,and 155. 38,respectively,all P〈 0. 05）. Conclusion Laparoscopic bilateral uterine artery occlusion combined with curettage for treatment of CSP has obvious advantages of minimal incision,high safety and less impact on endocrine.