Foley球囊压迫结合超声下宫腔镜清宫术治疗子宫瘢痕妊娠的临床疗效

Clinical efficacy of Foley balloon compression combined with ultrasound-guided hysteroscopic curettage in the treatment of cesarean scar pregnancy

目的分析Foley球囊压迫结合超声下宫腔镜清宫术治疗剖宫产术后子宫瘢痕妊娠患者的临床疗效。方法回顾性分析108例I/Ⅱ型子宫瘢痕妊娠患者临床资料,其中44例患者术前给予介入栓塞预处理(对照组),64例患者行超声下宫腔镜清宫术+Foley球囊压迫治疗(观察组)。比较两组患者手术成功率、术中大出血发生率、手术时间及住院时间、术后恢复情况、围术期β人绒毛膜促性腺激素(β-HCG)水平、围术期并发症发生情况及远期瘢痕修复情况。结果两组患者手术成功率、术中大出血发生率、手术时间、围术期并发症发生率、术后阴道流血持续及月经恢复、β-HCG降至正常水平时间均无显著差异(P>0.05)。观察组患者住院时间低于对照组(P<0.01)。两组患者术后β-HCG水平逐渐降低(P<0.05)。两组患者术后6个月瘢痕长度、瘢痕体积、残余肌层厚度及手术前后血清促卵泡刺激素、抗苗勒管激素、抑制素B水平均无显著差异(P>0.05)。结论超声监视下宫腔镜清宫术结合Foley球囊压迫对Ⅰ/Ⅱ型子宫瘢痕妊娠疗效好、安全性高,可缩短住院时间,值得临床推广。

Objective To analyze the clinical efficacy of Foley balloon compression(FBC)combined with ultrasound-guided hysteroscopic curettage in patients with cesarean scar pregnancy(CSP).Methods The clinical data of 108 typeⅠ/ⅡCSP patients were retrospectively analyzed,of them,44ones underwent interventional embolization pre-treatment before surgery(control group),and 64 ones did ultrasound-guided hysteroscopic curettage plus the FBC(observation group).Such indexes were compared between two groups as the success rates of surgery,incidences of intraoperative massive bleeding,operation times and lengths of hospital stay,postoperative recovery status,perioperativeβ-human chorionic gonadotropin(β-HCG)levels,the occurrence of perioperative complications,and long-term scar repair.Results Intergroup differences weren't statistically significant in the success rates of surgery,incidences of intraoperative massive bleeding,operation time,incidences of perioperative complications,postoperative vaginal bleeding duration and menstrual recovery,and the time forβ-HCG to falling to normal levels(P>0.05).The length of hospital stay was significantly shorter in observation than control group(P<0.01).Post-operative serumβ-HCG levels in both two groups lowered gradually(P<0.05).Intergroup differences weren't statistically significant in scar length,scar volume,residual muscle thickness in 6 months after surgery as well as pre-and post-operative serum follicle-stimulating hormone,anti-Mullerian hormone and inhibin B(P>0.05).Conclusion Ultrasound-guided hysteroscopic curettage plus the FBC has good efficacy and high safety in typeⅠ/ⅡCSP patients,can shorten the length of hospital stay and deserves clinical promotion.