22例剖宫产瘢痕妊娠综合治疗临床效果分析

Clinical analysis of comprehensive treatment of 22 cases of cesarean scar pregnancy

目的探讨和分析子宫动脉化疗栓塞术(uterine arterial chemoembolization,UACE)+经阴道剖宫产瘢痕妊娠病灶切除术治疗剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的临床应用效果。方法选取2014年10月至2016年10月在内蒙古医科大学附属医院行综合治疗的CSP患者共22例,观察患者的手术时间、术中出血量、血β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-hCG)下降情况及恢复正常时间、术后并发症情况、月经复潮时间以及总住院时间等,观察治疗效果。结果患者在手术中出血量少,手术时间短,术后住院时间短,手术成功率高,只有1例术中发生大出血改为开腹手术,但均治愈并成功保留子宫。手术以后监测患者血β-hCG数值均下降至正常。除出现下腹部疼痛、臀部疼痛、发热外,无其他并发症。结论 UACE联合经阴道剖宫产瘢痕妊娠病灶切除术治疗CSP具有微创、安全、有效的特点,是治疗CSP的理想手术方法,值得临床推广。

Objective To investigate and analyze the clinical application of uterine arterial chemoembolization （UACE） ＋ transvaginal excision in the treatment of cesarean scar pregnancy （CSP）. Methods A total of 22 patients with CSP who underwent comprehensive treatment from October 2014 to October 2016 at Affiliated Hospital oflnner Mongolia Medical University were selected. Operation time, intraoperative blood loss, the descent range and recovery time of serum β - hCG, the operative compications, the time of menstruation resume, and the hospitalization time of patients were observed to analyze the efficacy. Results With less bleeding, shorter operation time and postoperative hospital stay, higher success rate, only one case of severe bleeding changed to open surgery, but were cured and all patients successfully retained the uterus. After surgery the patients＇ blood β- hCG values were reduced to normal. In addition to abdominal pain, hip pain and fever, there were no other complications. Conclusion Transvaginal operation combined UACE in the treatment of CSP has the advantages of minimally invasive, high efficiency and safety. It is an ideal surgical method for CSP and is worthy of chnical promotion.