不同预处理方式联合超声监测下清宫术治疗外生型CSP的疗效及安全性

Efficacy and safety of different preconditioning methods combined with dilatation&curettage under ultrasonic monitoring in the treatment of exogenous cesarean scar pregnancy

目的探讨不同预处理方式联合超声监测下清宫术治疗外生型剖宫产瘢痕妊娠(CSP)的疗效和安全性。方法回顾性分析外生型CSP患者76例,其中40例(MTX组)采用囊液抽吸+甲氨蝶呤(MTX)孕囊内注射+米非司酮口服+超声监测下清宫术治疗,36例(UAE组)采用MTX灌注+子宫动脉栓塞(UAE)+米非司酮口服+超声监测下清宫术治疗。比较两组临床治愈率、术中出血量、中转开腹手术比例、β-HCG恢复时间、术后阴道流血时间、住院日数、住院费用、月经恢复时间、术后3个月输卵管通畅率、术后2年再妊娠率、术后3年CSP复发率、术后不良反应及并发症。结果UAE组临床治愈率、β-HCG恢复时间、住院费用高于MTX组(P<0.05),术中出血量、中转开腹手术率、阴道流血时间、住院日数低于MTX组(P<0.05)。UAE组月经恢复时间长于MTX组(P<0.05),但术后3个月输卵管通畅率、术后2年再妊娠率、术后3年CSP复发率比较,无统计学意义(P>0.05)。两组患者术后发热、白细胞下降、下腹疼痛、恶心呕吐发生率比较无统计学意义(P>0.05)。结论MTX灌注+UAE+米非司酮口服+超声监测下清宫术治疗外生型CSP的效果更为显著,且对患者远期生育能力无明显影响。

Objective To investigate the efficacy and safety of different preconditioning methods combined with dilatation&curettage under ultrasonic monitoring in the treatment of exogenous cesarean scar pregnancy(CSP).Methods A retrospective analysis was performed on 76 patients with exophytic CSP,of whom 40(MTX group)were treated with gestational sac aspiration+methotrexate(MTX)intracapsular injection+mifepristone oral administration+D&C under ultrasonic monitoring,and 36(UAE group)were treated with MTX perfusion+uterine artery embolization(UAE)+mifepristone oral administration+D&C under ultrasonic monitoring.Clinical cure rate,intraoperative blood loss,conversion to laparotomy ratio,β-human chorionic gonadotropin(β-HCG)recovery time,postoperative vaginal bleeding time,hospital stay days,hospital cost,menstrual recovery time,tubal patency rate 3 months after the operation,repregnancy rate 2 years after the operation,CSP recurrence rate 3 years after the operation,postoperative adverse reactions and complications were compared between the two groups.Results The clinical cure rate,β-HCG recovery time,hospitalization cost of UAE group were higher than those of MTX group(P<0.05),while the intraoperative blood loss,conversion rate to laparotomy,vaginal bleeding time and hospitalization days were lower than those of MTX group(P<0.05).The menstrual recovery time of UAE group was longer than that of MTX group(P<0.05).There were no statistically significant differences between the two groups in rate of fallopian tube patency 3 months after surgery,rate of repregnancy 2 years after surgery,and rate of CSP recurrence 3 years after surgery(P>0.05).Fever,leukocyte decline,lower abdominal pain,nausea and vomiting after surgery were not significantly different between the two groups(P>0.05).Conclusions MTX perfusion+UAE+mifepristone oral administration+D&C under ultrasonic monitoring is more effective in the treatment of exophytic CSP,and has no significant bad influence on long-term fertility.