宫腹腔镜+UAE与腹腔镜+修补术治疗Ⅲ型剖宫产瘢痕妊娠的疗效比较

Comparison of Hysteroscopy + Laparoscopy + UAE and Laparoscopy + Uterine Repair in the Treatment of Type Ⅲ Cesarean Scar Pregnancy

目的探讨Ⅲ型剖宫产瘢痕妊娠(CSP)的诊断和治疗方法。方法回顾性分析2013年1月至2016年12月武汉大学人民医院收治的47例Ⅲ型CSP患者的临床资料。根据治疗方法不同分为两组:栓塞组(20例)为子宫动脉栓塞术(UAE)预处理后行宫腹腔镜联合治疗,腹腔镜组(27例)行腹腔镜下子宫瘢痕妊娠病灶切除联合子宫下段修补术。对比分析两组患者术中出血量、住院时间、住院费用、β人绒毛膜促性腺激素(β-h CG)降至正常时间以及术后月经恢复时间。结果腹腔镜组术中出血量多于栓塞组[(83±21)m L比(50±17)m L],住院时间显著短于栓塞组[(6.9±1.0)d比(11.6±1.2)d],住院费用显著低于栓塞组[(12 409±1 128)元比(23 875±2 905)元](P<0.05或P<0.01)。两组术后β-h CG下降百分比比较差异无统计学意义(P>0.05)。两组术后β-h CG值降至正常时间比较差异无统计学意义(P>0.05)。腹腔镜组月经恢复时间显著短于栓塞组[(36±7)d比(50±14)d](P<0.05)。两组患者手术均成功,且未发生术后并发症。结论两种方法均可用于Ⅲ型CSP患者,应根据患者具体情况采用个体化治疗,对于有大出血倾向的患者考虑UAE预处理联合宫腹腔镜治疗;对于无大出血倾向的患者,腹腔镜下子宫瘢痕妊娠病灶切除联合子宫下段修补术具有住院时间和术后月经恢复时间较短、住院费用较低等优点,可作为Ⅲ型CSP患者优先使用的治疗方式。

Objective To explore the diagnosis and treatment of type Ⅲ cesarean scar pregnancy（ CSP）. Methods A total of 47 patients diagnosed with type Ⅲ CSP in Renmin Hospital of Wuhan University from Jan. 2013 to Dec. 2016 were analyzed retrospectively. According to the treatment,they were divided into a uterine artery embolization（ UAE） group（ 20 cases） which received UAE combined with laparoscopy and hysteroscopy,and a laparoscopy group（ 27 cases） which received laparoscopic resection of uterine scar combined with lower uterine segment repair. The amount of bleeding,the time of hospitalization,the hospitalization cost,the β-human chorionic gonadotropin（ β-h CG） recovering to the normal time after the surgery and postoperative menstrual recovery time of the two groups were compared and analyzed. Results The blood loss in the laparoscopy group was significantly higher than that in the UAE group[（ 83 ± 21） m L vs（ 50 ± 17） m L]（ P〈0. 05）. The time of hospitalization in the laparoscopy group was significantly shorter than that of the UAE group[（ 6. 9 ±1. 0） d vs（ 11. 6 ± 1. 2） d],and the hospitalization cost was significantly lower than that of the UAE group[（ 12 409 ±1 128） yuan vs（ 23 875 ± 2 905） yuan]（ P〈0. 05 or P〈0. 01）. There was no significant difference in the percentage ofβ-h CG between the two groups（ P〉0. 05）. There was no significant difference between the two groups in the time of postoperative β-h CG recovered to normal time（ P〉0. 05）. The menstrual recovery time in the laparoscopy group was significantly shorter than that in the UAE group[（ 36 ± 7） d vs（ 50 ± 14） d]（ P〈0. 05）. All patients in the two groups received successful operation,and no postoperative complications occurred. Conclusion Both methods can be used for the treatment of type Ⅲ CSP. For patients with major bleeding tendency,we should consider the combination of UAE pretreatment combined with hysteroscopy and laparoscopy. For patients without major bleeding tendency,laparoscopy combined with uterine repair has the advantages of shorter hospitalization time,shorter menstrual recovery time and lower hospitalization expenses,which can be a priority treatment for type Ⅲ CSP patients.