基于彩超“三分型”的剖宫产术后子宫疤痕部位妊娠的个体化治疗

Individualized treatment of cesarean scar pregnancy based on colorI Doppler ultrasound"three classifications

目的 探讨基于彩超“三分型”的剖宫产术后子宫疤痕部位妊娠(CSP)的个体化治疗。方法 选取2015年4月至2021年4月南京鼓楼医院集团宿迁医院收治的225例CSP患者作为研究对象,根据彩超检查结果分为Ⅰ型组(n=75)、Ⅱ型组(n=75)、Ⅲ型组(n=75)。Ⅰ型组37例采取药物治疗,38例采取清宫术;Ⅱ型组37例采取清宫术,38例采取宫腔镜疤痕组织切除术;Ⅲ型组37例采取腹腔镜疤痕组织切除术,38例采取宫腔镜疤痕组织切除。统计并比较三组的治疗效果。结果 Ⅰ型组清宫术月经恢复时间、人绒毛膜促性腺激素(β-HCG)恢复正常时间、首次治疗成功率均优于药物治疗(P<0.05)。宫腔镜疤痕组织切除术手术时间长于清宫术,术中出血量多于清宫术;Ⅱ型组宫腔镜疤痕组织切除术月经恢复时间、β-HCG恢复正常时间、首次治疗成功率均优于清宫术(P<0.05)。Ⅲ型组宫腔镜疤痕组织切除术手术时间、月经恢复时间、β-HCG恢复正常时间、术中出血量均优于腹腔镜疤痕组织切除术(P<0.05)。Ⅰ型组、Ⅱ型组、Ⅲ型组首次治疗成功率比较,差异无统计学意义(P>0.05)。结论 基于彩超“三分型”的个体化治疗方案治疗CSP效果确切,安全性良好。

Objective To explore the individualized treatment of cesarean scar pregnancy(CSP)after cesarean section based on color Doppler ultrasound"three classifications".Methods A total of 225 CSP patients in Nanjing Drum Tower Hospital Group Suqian Hospital from April 2015 to April 2021 were selected and divided into typeⅠgroup(n=75),typeⅡgroup(n=75)and typeⅢgroup(n=75)according to the results of color ultrasound examination.37 patients in the typeⅠgroup received drug treatment,and 38 patients received uterine curettage;in the typeⅡgroup,37 patients received uterine curettage,and 38 patients received hysteroscopic scar tissue resection;in the typeⅢgroup,37 patients received laparoscopic scar tissue resection,and 38 cases received hysteroscopic scar tissue resection.The therapeutic effects of the three groups were analyzed and compared.Results The time to recovery of menstruation after uterine curettage of typeⅠgroup,time to normalisation ofβ-human chorionic gonadotropin(β-HCG)and success rate of the first treatment were all better than that of drug treatment(P<0.05).Hysteroscopic scar tissue resection of typeⅡgroup took longer to perform than uterine curettage and had more intraoperative bleeding than curettage;the time to recovery of menstruation,time to normalisation ofβ-HCG and success rate of first treatment were all better than uterine curettage(P<0.05).Hysteroscopic scar tissue resection of typeⅢgroup was superior to laparoscopic scar tissue resection in terms of operative time,menstrual recovery time,β-HCG recovery time,intraoperative bleeding and first treatment success rate(P<0.05).There was no statistically significant difference in the first treatment success rate when comparing typeⅠ,typeⅡand typeⅢgroups(P>0.05).Conclusions The individualized treatment plan based on color Doppler ultrasound"three subtypes"has definite effect and good safety in the treatment of CSP.