腹腔镜下可逆性子宫动脉阻断治疗剖宫产瘢痕部位妊娠的临床价值

Clinical value of laparoscopic reversible uterine artery occlusion in treatment of cesarean section scar pregnancy

目的探讨腹腔镜下可逆性子宫动脉阻断治疗剖宫产瘢痕部位妊娠的临床价值。方法选取蚌埠医学院第一附属医院2018年9月至2020年6月期间住院的112例诊断为Ⅱ型及Ⅲ型剖宫产瘢痕部位妊娠患者,按随机数字表法将患者分为对照组(n=58)与观察组(n=54),对照组采用子宫动脉栓塞术联合腹腔镜下妊娠物清除及子宫瘢痕修补术,观察组采用腹腔镜下可逆性子宫动脉阻断后进行妊娠物清除术及子宫瘢痕修补术,对比两组患者临床治疗效果。结果对照组术中出血量(21.26±9.64)ml,显著小于观察组(75.25±8.25)ml(P<0.05);观察组治疗成功率为98.15%(53/54),显著高于对照组86.21%(50/58)(P<0.05);观察组阴道流血时间(7.26±0.94)d、术后月经回潮时间(31.25±1.26)d、住院时间(3.14±0.25)d,均显著小于对照组[(9.54±0.86)、(47.25±2.15)、(9.26±0.94d)](P<0.05);术后24 hβ-hCG水平及β-hCG转阴时间观察组[(1015.11±325.05)IU/L、(14.25±3.21)d]显著小于对照组[(2654.25±284.25)IU/L、(27.16±5.14)d](P<0.05);两组患者治疗前改良SF-36量表评分对比差异无统计学意义(P>0.05),观察组治疗后改良SF-36量表评分(63.22±4.25)分显著高于对照组(55.25±3.83)分(P<0.05)。结论腹腔镜下可逆性子宫动脉阻断治疗剖宫产瘢痕部位妊娠疗效确切,患者β-hCG水平显著降低、生活质量显著改善。

Objective To explore the clinical value of laparoscopic reversible uterine artery occlusion in the treatment of cesarean section scar pregnancy.Methods A total of 112 patients who were hospitalized in our hospital from Sep.2018 to Jun.2020 in the First Affiliated Hospital of Bengbu Medical College and diagnosed with type II and type III cesarean section scars were selected.The patients were divided into groups according to the randomization method,the control group(n=58)and the study group(n=54).The control group used uterine artery embolization combined with laparoscopic removal of pregnancy and uterine scar repair,while the study group used laparoscopic reversible uterine artery occlusion,pregnancy removal surgery and uterine scar repair surgery.The clinical treatment effects of the two groups of patients were compared.Results The intraoperative blood loss of the control group(21.26±9.64)ml was significantly less than that of the study group(75.25±8.25)ml(P<0.05);the treatment success rate of the study group was 98.15%(53/54),which was significantly higher than the control group 86.21%(50/58)(P<0.05);the time of vaginal bleeding in the study group(7.26±0.94)d,postoperative menstrual regain time(31.25±1.26)d,and hospital stay(3.14±0.25)d were significantly less than those in the control group[(9.54±0.94)0.86d,(47.25±2.15)d,(9.26±0.94)d](P<0.05);24 hβ-hCG level andβ-hCG negative time study group[(1015.11±325.05)IU/L,(14.25±3.21)d]was significantly less than the control group[(2654.25±284.25)IU/L,(27.16±5.14)d](P<0.05);there was no difference in the scores of the modified SF-36 scale before treatment between the two groups(P>0.05).The modified SF-36 scale score(63.22±4.25)of the study group after treatment was significantly higher than that of the control group(55.25±3.83)(P<0.05).Conclusions Laparoscopic reversible uterine artery occlusion is effective in treating cesarean section scar pregnancy.After treatment,theβ-hCG level of the patient is significantly reduced and the quality of life is significantly improved.