腹腔镜下子宫动脉临时阻断辅助微创手术治疗Ⅱ型或Ⅲ型剖宫产术后子宫瘢痕妊娠的临床效果

Clinical effect of laparoscopic uterine artery temporary occlusion assisted minimally invasive surgery on the treatment of typeⅡorⅢcesarean scar pregnancy

目的探讨腹腔镜下子宫动脉临时阻断辅助宫腹腔镜联合胚物清除及瘢痕修补术治疗Ⅱ型或Ⅲ型剖宫产术后子宫瘢痕妊娠(CSP)的临床效果。方法回顾性分析首都医科大学附属北京天坛医院2013年1月至2020年2月就诊的47例Ⅱ型或Ⅲ型CSP患者的临床资料。2013年1月至2018年12月的33例患者作为对照组,患者行药物处理后负压吸引胚物清除术,如果治疗失败行二次清宫、腹腔镜或开腹胚物清除及瘢痕修补术;2019年1月至2020年2月的14例患者作为腹腔镜组,患者行腹腔镜下子宫动脉临时阻断辅助宫腹腔镜联合胚物清除及瘢痕修补术。比较2组术后大出血发生率、胚物残留发生率、单次手术成功率、术后瘢痕憩室改善情况、住院时间、住院费用及术后随访3个月的情况。结果腹腔镜组大出血发生率、胚物残留发生率明显低于对照组,瘢痕憩室改善率明显高于对照组[0(0/14)比27.3%(9/33)、0(0/14)比33.3%(11/33)、92.9%(13/14)比18.2%(6/33)],差异均有统计学意义(均P<0.05)。腹腔镜组术前住院时间、总住院时间明显短于对照组,差异均有统计学意义(均P<0.05)。术后随访3个月,腹腔镜组月经量无明显变化,无闭经和宫腔粘连;对照组中17例术前行子宫动脉栓塞,其中1例卵巢早衰,1例宫腔粘连,3例月经减少。结论对Ⅱ型或Ⅲ型CSP腹腔镜下子宫动脉临时阻断辅助宫腹腔镜联合胚物清除及瘢痕修补术更加安全有效。

Objective To investigate the clinical effect of laparoscopic uterine artery temporary occlusion assisted hysteroscopic-laparoscopic embryo removal and scar repair on the treatment of typeⅡorⅢcesarean scar pregnancy(CSP).Methods The clinical data of 47 patients with typeⅡorⅢCSP in Beijing Tiantan Hospital,Capital Medical University from January 2013 to February 2020 were retrospectively analyzed.From January 2013 to December 2018,33 patients were selected as the control group.The patients were treated with negative pressure suction embryo removal after drug treatment.When the treatment failed,they were treated with secondary curettage,laparoscopic or open embryo removal and scar repair.From January 2019 to February 2020,14 patients were selected as the laparoscopic group.They were treated with laparoscopic uterine artery temporary occlusion assisted hysteroscopic-laparoscopic embryo removal and scar repair.The massive hemorrhage rate,embryo residue rate,success rate of single operation,improvement of scar diverticulum,length of stay,cost of hospitalization and3-month follow-up after operation were compared between the two groups.Results The rates of massive hemorrhage and embryo residue in the laparoscopic group were significantly lower than those in the control group,and the improvement rate of scar diverticulum in the laparoscopic group was significantly higher than that in the control group[0(0/14)vs 27.3%(9/33),0(0/14)vs 33.3%(11/33),92.9%(13/14)vs 18.2%(6/33)](all P<0.05).The preoperative length of stay and total length of stay in the laparoscopic group were significantly shorter than those in the control group(both P<0.05).The patients followed-up for 3 months,there was no significant change in menstrual volume,and no amenorrhea and intrauterine adhesions in the laparoscopic group;17 patients underwent uterine artery embolism before operation in the control group,including 1 case of premature ovarian failure,1 case of intrauterine adhesions and 3 cases of decreased menstruation.Conclusion It is more safe and effective of laparoscopic uterine artery temporary occlusion assisted hysteroscopic-laparoscopic embryo removal and scar repair on the treatment of typeⅡorⅢCSP.