阴式妊娠物清除术及子宫瘢痕修补术与介入治疗后清宫术对子宫疤痕妊娠患者近期和远期疗效的影响

Short-term and long-term clinical effect of vaginal pregnancies clearance and uterine scar repair and uterine curettage after intervention in treatment of uterine scar pregnancy

目的比较子宫疤痕妊娠患者采取阴式妊娠物清除及子宫瘢痕修补术与子宫动脉栓塞联合清宫术治疗的近远期疗效。方法选取2017年1月至2019年1月于惠州市第六人民医院诊治的子宫疤痕妊娠患者80例,随机分为清除组和介入组,每组40例,清除组采取阴式妊娠物清除术联合子宫瘢痕修补术,介入组给予子宫动脉栓塞术联合清宫术。比较两组患者手术情况、恢复情况、血清β-绒毛膜促性腺激素(β-hCG)水平及术后并发症情况,随访至术后1年,记录两组患者正常宫内妊娠率及复发率。结果清除组患者手术时间、住院时间、月经恢复时间、β-hCG恢复时间均短于介入组,术中出血量少于介入组(P<0.05);术前血清β-hCG水平在两组中差异无统计学意义(P>0.05),术后第3天、第7天,两组β-hCG水平均较术前明显下降,且清除组比介入组下降更显著(P<0.05);清除组手术并发症发生率低于介入组,术后1年正常妊娠率高于介入组,复发率低于介入组(P<0.05)。结论与子宫动脉栓塞联合清宫术相比,阴式妊娠物清除术联合子宫瘢痕修补术创伤更小、恢复更快、并发症更少、对再次正常妊娠的影响更小,值得在子宫疤痕妊娠中进行推广。

【Objective】To compare the short-term and long-term clinical effect of vaginal pregnancies clearance and uterine scar repair and uterine artery embolization combined with uterine curettage in treatment of patients with uterine scar pregnancy.【Methods】Eighty cases of uterine scar pregnancy who treated in our hospital from January 2017 to January 2019 were selected,and were randomly divided into the clearance group and the intervention group, with 40 cases in each group. The clearance group were given the vaginal pregnancy clearance combined with uterine scar repair, while the intervention group were given uterine artery embolization combined with uterine curettage. Then,the operation condition, recovery, serum level of beta-hCG and postoperative complications of two groups of patients were compared, and the normal intrauterine pregnancy rate and recurrence rate were recorded after follow-up for 1 year. 【Results】 The operation time, hospitalization time, menstrual recovery time and β-hCG recovery time in the clearance group were shorter than those in the intervention group, and the intraoperative bleeding volume was less than that in the intervention group, and the difference was statistically significant(P<0.05). There was no significant difference in preoperative serum β-hCG level between the two groups(P>0.05). On the 3 rd and 7 th day after operation, the level of β-hCG of two groups was significantly lower than that before operation, and the level of β-hCG in the clearance group was significantly lower than that in the intervention group, and the difference was statistically significant(P<0.05). The incidence of surgical complications in the clearance group was lower than that in the intervention group, the normal pregnancy rate one year after the operation was higher than that in the intervention group, the recurrence rate was lower than that in the intervention group, and the difference was statistically significant(P<0.05). 【Conclusion】 Compared with uterine artery embolization combined with uterine curettage,vaginal pregnant material removal combined with uterine scar repair has less trauma, faster recovery, fewer complications and it has less influence on the second normal pregnancy, thus it is worth promoting in uterine scar pregnancy.