子宫动脉栓塞术预处理后宫腹腔镜联合手术治疗瘢痕妊娠的疗效观察

Hysteroscopic plus laparoscopic surgery following UAE pretreatment for cesarean scar pregnancy

  • 摘要: 目的 探索在子宫动脉栓塞术(uterine artery embolization,UAE)预处理后,对瘢痕妊娠患者采用宫腹腔镜联合手术治疗的疗效。 方法 回顾性分析本院妇产科2012年1月- 2017年1月诊治的59例瘢痕妊娠病例资料,分为观察组(33例,采用UAE预处理+宫腹腔镜联合病灶切除修补术)和对照组(26例,采用UAE预处理+超声引导下清宫术),比较两组围术期指标和疗效。 结果 观察组初次治疗成功率100.0%,高于对照组的80.8%(P=0.008);观察组手术用时长于对照组(63.5±21.9) min vs (28.2±11.0) min,P< 0.001,住院天数少于对照组(6.9±2.5) d vs (8.4±3.2) d,P=0.047;两组手术出血量(84.1±30.3) ml vs (71.4±32.9) ml差异无统计学意义(P=0.130)。观察组术后阴道流血时间(12.6±5.8) d vs (17.9±8.2) d,P=0.005和血β-HCG降至正常水平时间(22.0±7.6) d vs (29.1±9.3) d,P=0.002均少于对照组。观察组瘢痕妊娠病灶治疗效果好于对照组(完全治愈率93.9% vs 50.0%,P=0.001)。 结论 UAE预处理+宫腹腔镜联合手术治疗各种类型的瘢痕妊娠,成功率高、治疗效果确切。

     

    Abstract: Objective To explore the clinical value of hysteroscopic plus laparoscopic surgery in the treatment of cesarean scar pregnancy patients with uterine artery embolization (UAE) pretreatment. Methods A retrospective analysis of clinical data about 59 cesarean scar pregnancy patients admitted to our hospital from January 2012 to January 2017 was performed. Patients in study group (n=33) were treated with UAE + hysteroscopic plus laparoscopic surgery, and the control group (n=26) with UAE + ultrasound guided curettage. The clinical outcomes of the two groups were recorded and compared. Results The initial treatment success rate of the study group was significantly higher than that of control group (100% vs 80.8%, P=0.008). Compared with control group, the operating time of the study group was longer (63.5±21.9) min vs (28.2±11.0) min, P< 0.001, while the average hospital stay was less (6.9±2.5) d vs (8.4±3.2) d, P=0.047. The amount of operative bleeding in two groups had no statistically significant difference (84.1±30.3)ml vs (71.4±32.9) ml, P=0.130. The time of vaginal bleeding and β-HCG return to normal in the study group were significantly less than those of control group (12.6±5.8) d vs (17.9±8.2) d, P=0.005; (22.0±7.6) d vs (29.1±9.3) d, P=0.002. And the curative effect rate of study group was higer than that of control group (93.9% vs 50.0%, P=0.001). Conclusion UAE +hysteroscopic + laparoscopic surgery is effective for all types of cesarean scar pregnancy with higher success rate.

     

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