四种手术方式治疗剖宫产切口瘢痕妊娠的临床疗效比较

Analysis of Curative Effect on Four Surgical Treatment Methods in Patients with Caesarean Scar Pregnancy

目的:比较四种手术方式治疗剖宫产切口瘢痕妊娠(CSP)的临床疗效。方法:回顾性分析2013年3月~2016年8月我院收治的86例CSP患者的临床资料。按手术方式不同分为四组,超声引导下清宫组(Ⅰ组,36例),子宫动脉栓塞+超声引导下清宫组(Ⅱ组,28例),经阴道子宫下段切开取胚组(Ⅲ组,15例)和子宫动脉栓塞术+腹腔镜CSP病灶切除组(Ⅳ组,7例)。结果:Ⅰ组患者治疗后1例因大出血治疗失败,1例出现感染性发热;Ⅱ组均治疗成功,但有1例发生子宫动静脉瘘;Ⅲ组和Ⅳ组患者均治疗成功,且无不良反应及并发症发生。Ⅰ组手术时间与Ⅱ组比较无明显差异(P>0.05),但均明显短于Ⅲ组和Ⅳ组(均P<0.05),Ⅲ组与Ⅳ组手术时间比较无明显差异(P>0.05)。Ⅳ组术中出血量明显小于其余三组,差异均有统计学意义(均P<0.05)。四组间住院时间比较,差异无统计学意义(P>0.05)。Ⅳ组患者住院总费用明显高于其余三组患者,差异均有统计学意义(均P<0.05)。结论:对于CSP患者,应当根据具体情况采用个体化治疗方案。子宫动脉栓塞术+腹腔镜CSP病灶切除术成功率高、并发症少、术中出血少、住院时间短,可作为CSP治疗的优选方案。

Objective:To compare the clinical efficacy of four surgical methods in the treatment of cesarean scar pregnancy(CSP).Methods:The clinical data of 86 patients with CSP admitted to our hospital from March 2013 to August 2016 were analyzed retrospectively.They were divided into four groups according to different surgical methods:ultrasound-guided uterine clearance group(group Ⅰ,36 cases),uterine artery embolization+ultrasound-guided uterine clearance group(group Ⅱ,28 cases),transvaginal hysterectomy group(groupⅢ,15 cases)and uterine artery embolization+laparoscopic CSP lesion resection group(groupⅣ,7 cases).Results:After treatment,there are 1 patient failed to treatment due to massive hemorrhage and1 patient developed infectious fever in groupⅠ.All patients in groupⅡsucceeded,but 1 patient had uterine arteriovenous fistula.All patients in group Ⅲ and Ⅳ were treated successfully without adverse reaction and complications.There was no significant difference in operation time between groupⅠand groupⅡ(P>0.05),which were all significantly shorter than that of groupⅢor groupⅣ(All P<0.05).There was no significant difference between groupⅢand groupⅣin operation time(P>0.05).The amount of intraoperative bleeding in groupⅣ was significantly less than that in other three groups,and the differences were all statistically significant(All P<0.05).There was no significant difference in length of hospital stay among the four groups(P>0.05).The total hospitalization cost of group Ⅳ was significantly higher than that of the other three groups(All P<0.05).Conclusion:For CSP patients,individualized treatment should be adopted according to the specific situation.Uterine artery embolization combined with laparoscopic CSP lesion resection has higher success rate,fewer complications,less intraoperative bleeding and shorter hospitalization time,which can be the preferred choice for CSP treatment.