阴式子宫瘢痕妊娠病灶切除联合子宫修补术治疗Ⅱ型/Ⅲ型剖宫产瘢痕妊娠患者的临床疗效

Clinical efficacy of vaginal scar pregnancy lesion resection combined with uterine repair for typeⅡ/Ⅲcesarean scar pregnancy patients

目的分析阴式子宫瘢痕妊娠病灶切除联合子宫修补术治疗Ⅱ型/Ⅲ型剖宫产瘢痕妊娠(CSP)患者的临床疗效及对患者术后恢复的影响,以期为临床制定CSP的治疗方案提供参考。方法回顾性选取2018年6月—2020年6月衡水市第二人民医院收治的103例Ⅱ型/Ⅲ型CSP患者,根据治疗方式不同分为对照组(50例)和研究组(53例)。对照组患者采用子宫动脉化疗栓塞术联合超声引导下清宫术治疗,研究组患者采用阴式子宫瘢痕妊娠病灶切除联合子宫修补术治疗。比较2组患者的临床疗效、手术指标、术后恢复情况以及治疗前后的孕酮、β-人绒毛膜促性腺激素(β-HCG)水平,同时比较2组患者随访2年的子宫瘢痕妊娠复发及正常妊娠情况。结果研究组患者的治疗总有效率为90.56%(48/53),高于对照组的74.00%(37/50),差异有统计学意义(χ^(2)=4.896,P=0.027)。2组患者治疗前孕酮及β-HCG水平比较,差异无统计学意义(P>0.05);2组患者治疗后孕酮及β-HCG水平均低于治疗前,且研究组均低于对照组,差异均有统计学意义(P<0.05)。研究组患者术中出血量少于对照组,手术时间长于对照组,下床时间、住院时间均短于对照组,差异均有统计学意义(P<0.05)。研究组患者术后正常月经恢复时间、阴道出血时间、β-HCG恢复正常时间、宫腔肿块消失时间均短于对照组患者,差异均有统计学意义(P<0.05)。研究组患者随访2年子宫瘢痕妊娠复发率为0(0/53),低于对照组患者的14.00%(7/50),差异有统计学意义(χ^(2)=5.904,P=0.015)。研究组患者随访2年正常妊娠率为66.04%(35/53),高于对照组34.00%(17/50),差异有统计学意义(χ^(2)=10.564,P=0.001)。结论阴式子宫瘢痕妊娠病灶切除联合子宫修补术治疗Ⅱ型/Ⅲ型CSP患者疗效显著,可减少患者术中出血量,促进患者术后恢复,且降低子宫瘢痕妊娠复发风险,提高正常妊娠率。

Objective To analyze the clinical efficacy of vaginal scar pregnancy lesion resection combined with uterine repair in treating patients with TypeⅡ/Ⅲcesarean scar pregnancy(CSP)and its impact on postoperative recovery,providing support for clinical treatment plans for CSP patients.Methods This retrospective study selected 103 TypeⅡ/ⅢCSP patients treated in our hospital from June 2018 to June 2020.Patients were assigned to control group(50 cases)study group(53 cases)based on different treatment methods.The control group underwent uterine artery chemoembolization combined with ultrasound-guided curettage,while the study group received vaginal scar pregnancy lesion resection combined with uterine repair.Clinical efficacy,surgical indicators,postoperative recovery,pre-and post-treatment progesterone,andβ-HCG levels were compared between the two groups.Additionally,the recurrence of cesarean scar pregnancy and normal pregnancy rates were compared during a two-year follow-up.Results The overall response rate in the study group was significantly higher than that in the control group[90.56%(48/53)vs.74.00%(37/50);χ^(2)=4.896,P=0.027].There was no significant difference in progesterone andβ-HCG levels between the two groups before treatment(P>0.05).Post-treatment,both progesterone andβ-HCG levels were significantly lower in the study group compared to the control group(P<0.05).The study group had less intraoperative blood loss,longer time of operation,and shorter time to ambulation and length of hospital stay compared to the control group,all with significant differences(P<0.05).Postoperative recovery time for normal menstruation,vaginal bleeding,β-HCG normalization,and disappearance of intrauterine masses were significantly shorter in the study group than in the control group(P<0.05).The two-year recurrence rate of cesarean scar pregnancy in the study group was significantly lower than that in the control group[0(0/53)vs.14.00%(7/50);χ^(2)=5.904,P=0.015].The twoyear normal pregnancy rate in the study group was significantly higher than that in the control group[66.04%(35/53)vs.34.00%(17/50);χ^(2)=10.564,P=0.001].Conclusion Vaginal scar pregnancy lesion resection combined with uterine repair is highly effective for treating patients with TypeⅡ/ⅢCSP.It reduces intraoperative blood loss,promotes postoperative recovery,decreases the recurrence risk of cesarean scar pregnancy,and increases the rate of normal pregnancy.