不同方案治疗Ⅱ型剖宫产瘢痕妊娠效果

Clinical effect of different operation schemes for treating women with typeⅡcesarean scar pregnancy

目的:对比不同处理方案联合宫腔镜下清宫术治疗Ⅱ型剖宫产瘢痕妊娠(CSP)的临床效果。方法:选择2018年2月—2019年1月在本院接受宫腔镜下清宫术治疗Ⅱ型CSP患者96例,随机数字表法分为两组各48例。对照组在子宫动脉栓塞后行宫腔镜下清宫术治疗,观察组采用米非司酮药物预处理后行宫腔镜下清宫术。对比两组手术、术后恢复、β人绒毛膜促性腺激素(β-hCG)下降及并发症发生等情况。结果:两组手术时间、术中出血量、中转开腹率及子宫切除率无差异(P>0.05)。观察组阴道出血时间(18.7±4.7d)、月经恢复时间(34.1±6.5d)及β-hCG恢复时间(26.8±6.0d)均短于对照组(P<0.05)。治疗后两组患者β-hCG下降率均随时间延长而明显增加,但观察组增加幅度更大,并发症总发生率观察组(29.2%)高于对照组(12.5%)(均P<0.05)。结论:采用药物预处理或子宫动脉栓塞联合宫腔镜下清宫术治疗Ⅱ型CSP均可获得有效治疗,但药物预处理治疗后患者恢复时间更短,但应注意并发症的防治。

Objective:To compare the clinical effect of different schemes combined with hysteroscopic curettage for treating women with typeⅡcesarean scar pregnancy(CSP).Methods:96 women with typeⅡCSP were treated with hysteroscopic curettage were included and were divided into two groups(48 cases in each group)from February 2018 to January 2019.The women in the control group were treated by hysteroscopic curettage after uterine artery embolization,and the women in the observation group were treated by hysteroscopic curettage after mifepristone pretreatment.The conditions of operation,postoperative recovery,andβ-hCG level decline situation,and complications rate of the women were compared between the two groups.Results:There were no significant differences in the operative time,the intraoperative blood loss,the rate of transfer to laparotomy,and the hysterectomy rate of women between the two groups(P>0.05).The vaginal bleeding time(18.7±4.7d),the menstrual recovery time(34.1±6.5d),and the time ofβ-HCG level recovery to normal(26.8±6.0d)of women in the observation group were significant shorter than those of women in the control group(P<0.05).After treatment,the rate ofβ-HCG level decreased of women in both groups had increased significantly with time extension,but the degreeβ-HCG level decline of women in the observation group was significant more than that of women in the control group(P<0.05).The total incidence of complications of women(29.2%)in the observation group was significant higher than that(12.5%)of women in the control group(P<0.05).Conclusion:Mifepristone pretreatment or uterine artery embolization combined with hysteroscopic curettage for treating women with typeⅡCSP both have effectiveness,but the recovery time of the women after mifepristone pretreatment is shorter.The prevention and treatment of the complications of these women should be paid more attention to.