超声介入下聚桂醇注射联合清宫术治疗剖宫产瘢痕妊娠的远期疗效观察

Observation of long-term efficacy of polidocanol injection combined with uterine curettage in the treatment of cesarean scar pregnancy under ultrasound intervention

目的探析超声介入下子宫瘢痕部位局部注射聚桂醇联合清宫术治疗剖宫产瘢痕妊娠的远期疗效及安全性。方法88例剖宫产瘢痕妊娠患者,随机分成研究组和对照组,各44例。研究组给予超声介入下聚桂醇注射联合清宫术治疗,对照组给予甲氨蝶呤(MTX)单剂量肌内注射联合清宫术治疗。比较两组再次妊娠率、孕期子宫破裂率、住院时间、月经恢复时间,并比较两组药物注射治疗前后病灶周围阻力指数(RI)以及清宫术后1个月、3个月子宫内膜厚度、瘢痕厚度。结果研究组再次妊娠率52.27%略高于对照组的34.09%,但差异无统计学意义(P>0.05)。两组均无孕期子宫破裂发生。研究组住院时间(4.24±4.80)d及月经恢复时间(38.93±7.94)d均明显短于对照组的(10.73±6.12)、(45.62±8.15)d,差异有统计学意义(P<0.05)。药物注射后,研究组病灶周围RI(0.62±0.21)明显高于本组治疗前的(0.41±0.16)及同期对照组的(0.48±0.20),差异均有统计学意义(P<0.05)。两组术后1个月、3个月子宫内膜厚度、瘢痕厚度比较,差异均无统计学意义(P>0.05)。结论超声介入下聚桂醇注射联合清宫术治疗剖宫产瘢痕妊娠对患者子宫内膜厚度、瘢痕厚度均无明显影响,术后患者子宫瘢痕处血供恢复良好、月经恢复时间明显比MTX治疗缩短,同时能良好地保存患者的生育力,值得临床进一步推广。

Objective To discuss and analyze the long-term efficacy and safety of polidocanol injection combined with uterine curettage in the treatment of cesarean scar pregnancy under ultrasound intervention.Methods A total of 88 cases of cesarean scar pregnancy were randomly divided into research group and control group,with 44 cases in each group.The research group was treated by polidocanol injection combined with uterine curettage under ultrasound intervention,and the control group was treated by intramuscular injection of single dose of methotrexate(MTX)combined with uterine curettage.The second pregnancy rate,uterine rupture rate during pregnancy,hospitalization time,menstrual recovery time,resistance index(RI)around the focus before and after drug injection,and the endometrial thickness and scar thickness 1 and 3 months after uterine curettage were compared between the two groups.Results The second pregnancy rate 52.27%of the research group was a little higher than that of the control group 34.09%,but the difference was not statistically significant(P>0.05).No uterine rupture occurred during pregnancy in both groups.The hospitalization time(4.24±4.80)d and menstrual recovery time(38.93±7.94)d of the research group were obviously shorter than those of the control group(10.73±6.12)and(45.62±8.15)d,and the difference was statistically significant(P<0.05).After drug injection,RI around the focus(0.62±0.21)of the research group was obviously higher than that before treatment(0.41±0.16)and the control group in the same period(0.48±0.20),and the difference was statistically significant(P<0.05).1 and 3 months after operation,there was no statistically significant difference in endometrial thickness and scar thickness between the two groups(P>0.05).Conclusion Polycinnol injection combined with uterine curettage under ultrasound intervention for cesarean scar pregnancy has no significant effect on the endometrial thickness and scar thickness of patients.After the operation,the blood supply of uterine scar recovers well,and the menstrual recovery time is significantly shorter than that of MTX treatment.At the same time,the fertility of the patients can be well preserved,and it is worth further clinical promotion.