宫腔镜治疗剖宫产术后子宫瘢痕妊娠效果及再妊娠结局分析

Analysis of the efficacy and later pregnancy outcomes of women with uterine scar pregnancy after treatment by hysteroscopy

目的:探讨宫腔镜治疗子宫瘢痕妊娠不全流产效果。方法:回顾性分析本院妇产科2015年1月-2017年3月收治的剖宫产术后子宫瘢痕妊娠不全流产患者临床资料68例,其中38例在双侧子宫动脉栓塞术下行宫腔镜手术切除残留妊娠组织并充分电凝止血,30例在双侧子宫动脉栓塞术下行传统的清宫手术并充分止血。比较两组手术情况及再妊娠结局。结果:两组手术时间、腹痛持续时间以及再妊娠结局未见差异(P>0.05)。宫腔镜组有1例术中转为腹腔镜手术,传统术组有8例转为腹腔镜手术、1例转为开腹手术。宫腔镜组1次手术成功率(97.4%)、平均术后住院时间[4.3d(4~8d)]、术中出血量[(21.5ml(5~50ml)]及术后出血持续时间[4.7d(2~12d)]均低于传统术组,平均术后绒毛膜促性腺激素恢复时间[23 d(20~29 d)]短于传统术组(P<0.05)。随访12~24个月,两组共52次自然妊娠,在再妊娠结局中宫腔镜组自然流产率(10.7%)低于传统术组(37.5%)(P<0.05),余再妊娠结局指标两组未见差异(P>0.05)。结论:在双侧子宫动脉栓塞术下行宫腔镜治疗子宫瘢痕妊娠不全流产较传统清宫术创伤小、出血量少、手术成功率更高、术后恢复更快,再妊娠发生自燃流产比例低于传统清宫术。

Objective: To investigate the efficacy of hysteroscopy for treating incomplete abortion of women with uterine scar pregnancy(USP). Methods: From January 2015 to March 2017, 68 women with USP after cesarean section and incomplete abortion were selected in this study, which included 38 women who underwent hysteroscopy after bilateral uterine artery embolization were in the observation group, and 30 women who underwent traditional uterine clearance and adequate hemostasis after bilateral uterine artery embolization were in the control group. The operation situation and pregnancy outcomes of women were compared between the two groups. Results:There were no significant different in the operation time, duration of abdominal pain, and later pregnancy outcomes of women between the two groups(P>0.05). In the observation group, 1 woman had been converted to laparoscopic operation, while in the control group, 8 women had been converted to laparoscopic operation and 1 woman had been converted to open operation. The success rate of operation, the hospital stay time after operation, the amount and the duration of bleeding after operation, of women in the observation group were 97.4%, 4.3 days(4-8 d), 21.5 ml(5-50 ml), and 4.7 days(2-12 d), respectively, which were significant lower than those of women in the control group(P<0.05). The recovery time of HCG level of women after operation in the observation group was 10.7%, which was significant lower than that of women in the control group(P<0.05). There were no significant difference in the other indicators of pregnancy outcomes between the two groups(P>0.05). Conclusion: Compared to the traditional curettage, hysteroscopy with bilateral uterine artery embolization is an ideal method for treating incomplete abortion of scar pregnancy,which has fewer traumas,less bleeding,higher success rate,faster recovery,and lower rate of spontaneous abortion in next pregnancy.