超声评分系统指导下剖宫产瘢痕妊娠不同处理方式的安全性及有效性评价

Evaluation on safety and effectiveness of ultrasonographic scoring system in different treatment methods for cesarean scar pregnancy

目的对超声评分系统下不同风险组剖宫产瘢痕妊娠不同处理方式的安全性及有效性进行比较和评价。方法回顾性分析2018年11月至2019年12月于陆军军医大学第二附属医院妇产科住院手术治疗的299例剖宫产瘢痕部位妊娠的病例资料。根据术前超声评分系统将患者分为高风险组(评分>4分)和低风险组(评分≤4分),低风险组行B超引导下清宫术,高风险组行子宫动脉栓塞术+B超引导下清宫术。收集患者基本信息、围术期资料及术后随访资料并进行统计学分析。结果两组患者术中出血量差异无统计学意义。两组治疗后需再次行子宫动脉栓塞术的发生率差异无统计学意义,而需要再次腹腔镜下瘢痕妊娠病灶去除术的发生率差异有统计学意义(P<0.05)。两组患者住院时间和花费差异有统计学意义(P<0.05)。两组患者术后血清β-HCG水平恢复至正常的时间、B超子宫下段异常回声消失的时间、月经恢复正常的时间差异均有统计学意义(P<0.05)。而治疗后两组患者再次妊娠的结局差异无统计学意义。结论根据术前超声评分系统,对不同风险组的剖宫产瘢痕妊娠选择相应的处理方式均安全有效。

Objective To evaluate and compare the efficacy and safety of different managements for women with cesarean scar pregnancy based on a ultrasonographic scoring system.Methods A total of 299 pregnant women with cesarean scar undergoing delivery surgeries in our department from November 2018 to December 2019 were recruited retrospectively.According to the preoperative results of the ultrasonographic scoring system,they were divided into low-risk group(score≤4)and high-risk group(score>4).The patients in the low-risk group were treated with ultrasound-guided curettage.And those of the other group were treated with uterine artery embolization and ultrasound-guided curettage.The basic information,perioperative data and postoperative follow-up data of the patients were collected and analyzed.Results There was no statistical difference in the amount of intraoperative blood loss between the 2 groups(P>0.05),neither the incidence of secondary uterine artery embolization between them(P>0.05).But significant difference was found in the incidence of secondary laparoscopic procedure for removing scar tissues between the 2 groups(P<0.05).What’s more,there were obvious differences in the length of hospital stay and total cost,the time of postoperative serumβ-HCG level dropping to normal,the time of disappearance of the abnormal echoes in the lower segment of the uterus,and the restoration of normal menstruation between the 2 groups(P<0.05).However,there was no statistical significance of the outcome of the second pregnancy between them after treatment.Conclusion According to the preoperative ultrasonographic scoring system for cesarean scar pregnancy,patients in different treatment methods.