阴式剖宫产瘢痕妊娠清除与子宫动脉栓塞加清宫治疗剖宫产瘢痕妊娠分析

Analysis of transvaginal surgery and uterine artery embolization combined with uterine curettage for treating women with cesarean scar pregnancy

目的:比较阴式剖宫产瘢痕妊娠清除与子宫动脉栓塞(UAE)加清宫治疗剖宫产术后瘢痕妊娠(CSP)疗效及对患者生活质量影响。方法:回顾性分析2016年10月—2018年3月本院接受治疗的剖宫产瘢痕妊娠孕妇106例临床资料。根据不同治疗方式分为观察组63例,对照组43例。观察组行阴式CSP组织清除术,对照组采取UAE联合清宫术治疗。观察两组术前术后血清β-人绒毛膜促性腺激素(β-hCG)水平,随访并发症及临床疗效,参照WHO生活质量测定量表(WHOQOL)进行生活质量评价。结果:观察组总有效率(96.8%)大于对照组(88.4%),两组术后第7、14天血清β-hCG水平均较术前降低,且观察组低于对照组,观察组手术时间、术中失血量大于对照组,术后24h体温及术后患者疼痛比例均低于对照组,住院、阴道出血、β-hCG转阴、月经复潮等时间均短于对照组,生理方面、社会关系方面评分高于对照组(均P<0.05),而心理方面、环境方面评分两组无差异(P>0.05)。结论:阴式剖宫产瘢痕妊娠清除治疗CSP可提高临床疗效,术后康复快,改善患者术后生理及社会关系方面的生活质量更佳,手术质量有待完善。

Objective: To compare the effect of transvaginal surgery and uterine artery embolization (UAE) combined with uterine curettage for treating women with cesarean scar pregnancy (CSP). Methods: The clinical data of 106 women with CSP from October 2016 to March 2018 were retrospectively analyzed. They were divided into observation group (n=63) and control group (n=43) according to different treatment methods. The CSP of women in the observation group were treated by transvaginal surgery, and the women in the control group were treated by UAE combined with UAE) combined with uterine curettage. The levels of serum β-human chorionic gonadotropin (β-hCG) of all women were detected before and after operation. The complication rate and clinical efficacy of women were followed up. The quality of life of all women was evaluated by WHO quality of life scale. Results: The total effective rate of women in the observation group was 96.8%, which was significant higher than that (88.4%) of women in the control group ( P <0.05). On the 7th and 14th day after operation, the level of serum β-hCG of women in both groups had significantly decreased ( P <0.05), and the level of serum β-hCG of women in the observation group was significant lower than that of women in the control group ( P <0.05). The operation time and the amount of blood loss during operation of women in the observation group were significant higher than those of women in the control group ( P <0.05). The body temperature at 24 hours after operation and the pain rate of women in the observation group were significant lower than those of women in the control group ( P <0.05). The scores of physiological and social relations of women in the observation group were significant higher than those of women in the control group ( P <0.05). There was no difference in psychological and environmental scores of women between the two groups ( P >0.05). Conclusion: Transvaginal surgery for treating women with CSP can improve the clinical efficacy and the recovery quickly after operation, which can improve the quality of life of women in physiological and social relations, but the quality of operation needs to be improved.