不同分型瘢痕妊娠聚桂醇治疗的疗效探究

Study on the efficacy of lauromacrogol in different types of scar pregnancy

目的探讨不同分型瘢痕妊娠聚桂醇治疗的临床疗效。方法回顾性分析杭州市妇产科医院2021年1月至2022年6月收治的瘢痕妊娠孕妇96例,其中Ⅰ型42例,Ⅱ型45例,Ⅲ型9例。经超声引导下聚桂醇+清宫术治疗64例,行子宫动脉栓塞(uterine artery embolization,UAE)+清宫术治疗32例。比较不同分型瘢痕妊娠治疗的临床效果。结果不同分型瘢痕妊娠孕妇的绒毛膜厚度、孕囊最大径、前峡部肌层厚度、前峡部血流分级比较差异均有统计学意义(P<0.05),其中Ⅱ型孕妇的绒毛膜厚度、前峡部血流分级均显著大于Ⅰ型(P<0.05);Ⅱ型孕妇的孕囊最大径显著大于Ⅰ型与Ⅲ型(P<0.05);Ⅱ型和Ⅲ型孕妇的前峡部肌层厚度显著小于Ⅰ型(P<0.05)。不同分型瘢痕妊娠孕妇的术后妊娠物残留比较差异无统计学意义(P>0.05),但术中出血量比较差异有统计学意义(P<0.05),Ⅱ型孕妇术中出血量≥100ml的比例高于Ⅰ型和Ⅲ型。聚桂醇+清宫术治疗患者的住院天数显著少于UAE+清宫术,内膜血管指数、血管化血流指数显著大于UAE+清宫术(P<0.05)。结论聚桂醇+清宫术和UAE+清宫术均可有效清除妊娠组织,但聚桂醇+清宫术治疗住院时间短,对子宫内膜血流的恢复优于UAE。

Objective To investigate the clinical effect of different types of scar pregnancy treated with lauromacrogol.Methods A total of 96 pregnant women with scar pregnancy admitted to Hangzhou Women’s Hospital from January 2021 to June 2022 were retrospectively analyzed,including 42 cases of typeⅠ,45 cases of typeⅡand 9 cases of typeⅢ.64 cases were treated with ultrasound-guided lauromacrogol+evacuation of uterus,and 32 cases were treated with uterine artery embolization(UAE)+evacuation of uterus.To compare the clinical effect of different types of scar pregnancy treatment.Results There were statistically significant differences in chorionic thickness,gestational sac maximum diameter,anterior isthmus muscle thickness and anterior isthmus blood flow grading among scar pregnancy with different types(P<0.05).The chorionic thickness and anterior isthmus blood flow grading of typeⅡpregnant women were significantly higher than those of typeⅠ(P<0.05),gestational sac maximum diameter in typeⅡpregnant women was significantly larger than that in typeⅠand typeⅢ(P<0.05),anterior isthmus muscle thickness in typeⅡand typeⅢpregnant women was significantly less than that in typeⅠ(P<0.05).There was no significant difference in postoperative residual pregnancy with different types of scar pregnancy(P>0.05),but there was significant difference in intraoperative blood loss(P<0.05).The proportion of intraoperative blood loss≥100ml in typeⅡpregnant women was higher than that in typeⅠand typeⅢ(P<0.05).The length of hospital stay of patients treated with lauromacrogol+evacuation of uterus was significantly less than that of UAE+evacuation of uterus,and the endometrial vascular index and vascularization flow index were significantly greater than that of UAE+evacuation of uterus(P<0.05).Conclusion Both lauromacrogol+evacuation of uterus and UAE+evacuation of uterus can effectively remove pregnancy tissue,but lauromacrogol+evacuation of uterus have shorter hospital stay and better recovery of endometrial blood flow than UAE.