Ⅱ型和Ⅲ型子宫瘢痕妊娠不同手术方式治疗效果的临床研究

Clinical Study on the Effect of Different Surgical Treatment of Type Ⅱ and Type Ⅲ Cesarean Scar Pregnancy

目的探讨子宫动脉栓塞介入术(uterine artery embolization,UAE)后行宫腔镜下清宫术、阴式手术局部切除子宫瘢痕处妊娠物及腹腔镜下子宫瘢痕处妊娠物切除术+宫腔镜下探查术在治疗Ⅱ型或Ⅲ型剖宫产术后子宫瘢痕妊娠(cesarean scar pregamncy,CSP)的临床效果。方法纳入宁波市妇女儿童医院2013年1月～2017年12月收治的75例Ⅱ型或Ⅲ型CSP患者,将患者随机分为3组,A组25例,B组25例,C组25组。其中A组患者接受UAE后行宫腔镜下清宫术; B组患者接受阴式手术局部切除子宫瘢痕处妊娠物; C组患者接受腹腔镜下子宫瘢痕处妊娠物切除术+宫腔镜下探查术,分析比较不同分型及不同治疗方法的CSP临床治疗效果。结果Ⅱ型与Ⅲ型CSP患者比较,Ⅲ型患者出血量较多、住院时间、血HCG恢复时间及月经恢复时间均较长,差异均有统计学意义(P <0. 05)。两组患者手术时间及住院费用比较,差异无统计学意义(P> 0. 05)。将3种治疗方法分别进行比较,A组、B组和C组CSP患者比较,C组患者出血量较少、血HCG恢复时间及月经恢复时间均较短、住院费用较低,差异有统计学意义(P <0. 05)。A组患者手术时间较短,3组患者住院时间比较,差异无统计学意义。Ⅱ型患者中,C组患者出血量较少、血HCG恢复时间及月经恢复时间均较短、住院费用较低,差异有统计学意义(P <0. 05)。A组患者手术时间、住院时间均较短,差异有统计学意义(P <0. 05)。Ⅲ型患者中,C组患者出血量较少、血HCG恢复时间及月经恢复时间均较短、住院费用较低,差异有统计学意义(P <0. 05)。A组患者手术时间较短,3组患者住院时间比较,差异无统计学意义。结论新型分型对于CSP的诊断、治疗及预后评估均具有较高的临床价值,Ⅲ型CSP患者应更为关注出血量,血HCG恢复时间及月经恢复时间较长,应引起重视。UAE后行宫腔镜下清宫术的治疗方法与阴式手术局部切除子宫瘢痕处妊娠物及腹腔镜下子宫瘢痕处妊娠物切除术+宫腔镜下探查术的治疗方法比较,腹腔镜下子宫瘢痕处妊娠物切除术+宫腔镜下探查术的治疗方式使患者的出血量减少,住院费用较低,血HCG恢复时间及月经恢复时间较快,安全性较高。

Objective To explore uterine artery embolization(UAE)followed by hysteroscopic hysteroscopic surgery,vaginal excision of the local uterine scar at the place of pregnancy,and laparoscopic uterine scar at the site of pregnancy resection+hysteroscopic exploration in the clinical effect of treatment of cesarean scar pregamncy(CSP)after typeⅡor typeⅢcesarean section.Methods A total of 75patients with typeⅡor typeⅢCSP admitted to the Ningbo Women and Children Hospital from January 2013 to December 2017 were randomly divided into three groups,induding Group A 25 patients,Group B 25 patients,Group C 25 group.Patients in group A underwent hysteroscopic hysteroscopic surgery after receiving UAE;patients in group B underwent vaginal surgery for local excision of uterine scars;patients in group C underwent laparoscopic uterine scars at pregnancy with hysterectomy and hysteroscopy.Analysis and comparison of different types and different treatment methods of clinical treatment of CSP was performed.Results Compared with typeⅡand typeⅢCSP patients,typeⅢpatients had more blood loss,hospitalization time,blood HCG recovery time and menstrual recovery time were longer,with significant differences(P<0.05).There was no significant difference in operation time and hospitalization costs between the two groups(P>0.05).The three treatment methods were compared.Compared with CSP patients in group A,B,and C,patients in group C had less blood loss,shorter time to recovery of HCG blood,shorter menstrual recovery time,and lower hospitalization costs.Significant difference was statistically significant(P<0.05).The operation time of the patients in group A was shorter.There was no significant difference in hospital stay between the three groups.In typeⅡpatients,patients in group C had less blood loss,shorter recovery time of blood HCG and menstrual recovery,and lower hospitalization costs,all with significant differences(P<0.05).Patients in group A had surgery.The time and length of stay were all shorter,with significant differences(P<0.05).In typeⅢpatients,patients in group C had less blood loss,shorter recovery time of blood HCG and menstrual recovery,and lower hospitalization costs,with significant differences(P<0.05).Patients in group A had surgery.The time was short,and there was no significant difference in hospital stay between the three groups.Conclusion The new classification has a high clinical value for the diagnosis,treatment and prognosis evaluation of CSP.Patients with type III CSP should pay more attention to the amount of blood loss.The recovery time of blood HCG and the recovery time of menstruation should be paid more attention.Hysteroscopic hysteroscopic surgery for UAE after hysteroscopic surgery compared with vaginal surgery for local resection of uterine scars and laparoscopic surgery for hysterectomy and hysteroscopy for laparoscopic uterine scars.The treatment of pregnancy with excision and hysteroscopy at the scar reduced the patient′s blood loss,hospitalization costs,blood HCG recovery time,menstrual recovery time,and safety.