宫腹腔镜下电吸人流术与子宫动脉栓塞术治疗Ⅱ型瘢痕妊娠临床疗效对比研究

Comparison of therapeutic effects between hysteroscopic electrosuction and artificial abortion and uterine artery embolization in treatment of type Ⅱ scar pregnancy

目的:探讨宫腹腔镜下电吸人流术与子宫动脉栓塞术治疗Ⅱ型瘢痕妊娠的临床疗效。方法:选取100例Ⅱ型瘢痕妊娠患者为研究对象,根据治疗方法分为对照组和试验组各50例。对照组行子宫动脉栓塞术治疗,试验组行宫腹腔镜下电吸人流术治疗,比较两组临床疗效、手术指标、血清指标、住院时间、住院费用、术中更改治疗手段发生率、患者对治疗满意度及随访结果。结果:两组临床总有效率比较(96.00%与86.00%),试验组明显高于对照组(P<0.05)。试验组首次月经时间及β-人绒毛膜促性腺激素(β-HCG)恢复正常时间短于对照组,妊娠组织残留率低于对照组(均P<0.05);两组术中出血量、住院时间、治疗费用两组比较无统计学差异(均P>0.05);与对照组术后1周比较,试验组术后1周血清微小RNA323-3p(miR-323-3p)、抑制素-A(INH-A)、血管内皮生长因子(VEGF)降低更显著(均P<0.05);两组术中更改治疗手段总发生率比较无统计学差异(P>0.05)。试验组治疗总满意度为98.00%,显著高于对照组的88.00%(P<0.05);两组术后1年内再次妊娠率比较无统计学差异(P>0.05);两组术后1年内均未出现瘢痕妊娠复发情况。结论:宫腹腔镜下电吸人流术可减轻Ⅱ型瘢痕妊娠患者的创伤,有效减少妊娠组织残留率,促进患者康复;且该手术方式并未增加术中出血量、住院时间及治疗费用,安全性较高,患者治疗满意度高。

Objective:To explore the curative effect of hysteroscopic electroaspiration and uterine artery embolization in the treatment of typeⅡscar pregnancy.Methods:A total of 100 patients with typeⅡscar pregnancy were selected and divided into control group and experimental group with 50 cases each according to the treatment method.The control group was treated with uterine artery embolization,and the experimental group was treated with hysteroscopic electrosuction and artificial abortion.The curative effect,surgical indexes,serum indexes,hospitalization time,hospitalization cost,incidence of intraoperative treatment change,patients’treatment satisfaction and follow-up results were compared between the two groups.Results:The total clinical effective rate in the experimental group was significantly higher than that in the control group(96.00%vs.86.00%,P<0.05).The first menstruation time andβ-HCG was shorter than those of the control group,and the residual rate of pregnancy tissue was lower than that of the control group(all P<0.05).There were no significant differences between the two groups in the amount of intraoperative bleeding,hospital stay and treatment costs(all P>0.05).Compared with the control group one week after operation,the serum levels of miR-323-3p,inhibin-A(INH-A)and VEGF in the experimental group decreased significantly(all P<0.05).There was no significant difference between the two groups in the total incidence of intraoperative treatment changes(P>0.05).The total satisfaction of treatment in the experimental group was 98.00%,significantly higher than 88.00%in the control group(P<0.05).There was no significant difference in the rate of second pregnancy between the two groups within 1 year after operation(P>0.05).There was no recurrence of scar pregnancy in both groups within 1 year after operation.Conclusion:The hysteroscopic electrosuction and artificial abortion can alleviate the trauma of patients with typeⅡscar pregnancy,effectively reduce the residual rate of pregnancy tissue,and promote the rehabilitation of patients.Moreover,this operation method does not increase the amount of intraoperative bleeding,hospital stay and treatment costs.It has high safety and high patient satisfaction.