子宫动脉化疗栓塞术结合腹腔镜下清宫术在剖宫产瘢痕妊娠保守治疗中的应用

Application of Uterine Arterial Embolization and Laparoscopic Dilatation and Curettage in the Conservative Treatment of Cesarean Scar Pregnancy

目的研究子宫动脉化疗栓塞术(UACE)结合腹腔镜下清宫术方案在剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)保守治疗中的临床应用效果。方法方便选取2014年2月—2016年12月该院收治的40例CSP病例纳入研究,按照随机数字表法平均分为2组,A组予以腹腔镜下清宫术,B组实施UACE结合腹腔镜下清宫术方案,比较2组手术相关指标、住院时间、人绒毛膜促性腺激素(HCG)转阴时间、峡部包块完全消失时间、月经恢复与并发症情况。结果A组术中出血量(218.34±80.25)m L、大出血发生率30.00%,均显著高于B组(45.78±16.32)m L与0.00%(P<0.05),且手术时间(57.19±11.64)min、住院时间(17.23±5.62)d、HCG转阴时间(45.18±4.06)d及包块完全消失时间(61.48±5.37)d,明显长于B组(20.35±10.48)min、(11.04±3.89)d、(24.71±2.84)d、(38.75±7.64)d(P<0.05);A组3个月内月经恢复率40.00%,明显低于B组75.00%(P<0.05),而并发症总发生率40.00%,显著高于B组10.00%(P<0.05)。结论在CSP保守治疗过程中采取UACE结合腹腔镜下清宫术方案,可减少术中出血量,降低大出血风险,并且缩短手术时间,加快患者康复进程,并发症少,具有推广价值。

Objective To research the clinical application effect of uterine arterial embolization and laparoscopic dilatation and curettage in the conservative treatment of cesarean scar pregnancy. Methods 40 cases of CSP cases admitted and treated in our hospital from February 2014 to December 2016 were convenient selected and randomly divided into two groups,the group A and group B respectively adopted the laparoscopic dilatation and curettage and UACE and laparoscopic dilatation and curettage, and the operation related indexes, length of stay, HCG clearance time, total disappearance time of isthmic mass, menstrual recovery and complications were compared between the two groups. Results The intraoperative bleeding amount and incidence rate of hemorrhea in the group A were obviously higher than those in the group B, [（218.34 ±80.25）m L, 30.00% vs（45.78 ±16.32）m L, 0.00% ]（P 0.05）, and the operation time, length of stay, HCG clearance time and total disappearance time of masses in the group A were obviously longer than those in the group B, [（57.19±11.64）min,（17.23±5.62）d,（45.18±4.06）d,（61.48±5.37）d vs（20.35±10.48）min,（11.04±3.89）d,（24.71±2.84）d,（38.75±7.64）d],（P〈0.05）,and the menstruation recovery rate in 3 months in the group A was obviously lower than that in the group B（40.00% vs75.00%）,（P〈0.05）, and the total incidence rate of complications was obviously higher than that in the group B（40.00% vs10.00%）,（P〈0.05）. Conclusion The UACE and laparoscopic dilatation and curettage in the conservative treatment of cesarean scar pregnancy in the conservative treatment of CSP can reduce the intraoperative bleeding amount, reduce the hemorrhea risk, shorten the operation time and accelerate the rehabilitation process with fewer complications, and it is worth promotion.