[1]石晓燕*,汪钰清,李琼.阴式剖宫产瘢痕妊娠组织清除术与子宫动脉栓塞术联合刮宫术的效果比较[J].中国计划生育和妇产科,2017,(11):38-42.
　SHI Xiao-yan*,WANG Yu-qing,LI Qiong.Comparison of the effect of vaginal cesarean scar pregnancy tissue removal and uterine artery embolization combined with curettage[J].Chinese Journal of Family Planning & Gynecotokology,2017,(11):38-42.
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阴式剖宫产瘢痕妊娠组织清除术与子宫动脉栓塞术联合刮宫术的效果比较
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《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2017年11期
页码:
38-42
栏目:
论著与临床
出版日期:
2017-11-25

文章信息/Info

Title:
Comparison of the effect of vaginal cesarean scar pregnancy tissue removal and uterine artery embolization combined with curettage
作者:
石晓燕*; 汪钰清; 李琼
内江市第二人民医院妇产科
Author(s):
SHI Xiao-yan*; WANG Yu-qing; LI Qiong
Department of Obstetrics and Gynecology，The Second People's Hospital of Neijiang，Neijiang Sichuan 641100，P.R.China
关键词:
阴式剖宫产瘢痕妊娠组织清除术; 剖宫产瘢痕妊娠; 子宫动脉栓塞术; 刮宫术
Keywords:
vaginal cesarean scar pregnancy tissue removal;  caesarean scar pregnancy;  uterine artery embolization;  uterine curettage　　
分类号:
R 71422
摘要:
目的观察阴式剖宫产瘢痕妊娠(cesarean scar pregnancy, CSP)组织清除术治疗CSP的应用效果，并与子宫动脉栓塞术（uterine artery embolization ,UAE）联合刮宫术的临床疗效进行比较。方法回顾性分析2015年7月至2016年10月内江市第二人民医院妇产科收治的158例CSP患者的病历资料，根据不同治疗方式分为观察组77例，对照组81例。观察组患者行阴式CSP组织清除术，对照组患者采取UAE联合刮宫术治疗,比较两组治疗效果、治疗后血清孕酮、孕囊直径等情况。结果观察组手术时间、β-人绒毛膜促性腺激素（β-human chorionic gonadotropin,β-hCG）恢复正常的时间长于对照组（P＜005）；两组术中出血量、中转开腹率、治疗有效率比较，差异无统计学意义（P>005）；对照组术后经期延长率、宫腔粘连率高于观察组（P＜005）；通过对患者的生存质量评分发现，观察组患者生理和社会关系方面的评分均高于对照组，差异有统计学意义（P＜005）；观察组经治疗后阴道出血时间、月经恢复时间、患者住院费用和住院时间均少于对照组（P＜005）；术后行超声检查，观察组未发现病灶，而对照组病灶消失时间平均为（2483±716）d。结论阴式CSP组织清除术与UAE联合刮宫术治疗CSP的有效率相当，但手术时间短、β-hCG恢复快，且患者生理及社会关系方面改善更佳，不失为一种有效的外科术式。
Abstract:
ObjectiveTo observe the effect of cesarean scar pregnancy (CSP) tissue resection in the treatment of CSP, and to compare with the clinical efficacy of uterine artery embolization(UAE) combined with curettage in order to provide clinical reference. MethodsRetrospective analysis of 158 patients with CSP treated in Department of Obstetrics and Gynecology, Neijiang Second People's Hospital from July 2015 to October 2016.The cases were divided into observation group (77 cases) and control group (81 cases) according to different treatment methods. The observation group were treated with vaginal CSP tissue removal while the control group were treated with UAE combined with curettage. The therapeutic effect,serum progesterone and gestational sac diameter of the two groups were compared after treatment. ResultsIn the observation group, the time of operation and human chorionic gonadotropin(β-hCG) returned to normal was longer than that of the control group(P＜005).There were no significant differences in the blood loss between the two groups(P>005). There was no significant difference between the two groups in the conversion rate and the effective rate of treatment(P>005). The postoperative menstruation rate and intrauterine adhesion rate of the control group was higher than those of the observation group(P<005). The scores of physiology and social relationship were significantly lower in the observation group than those in the control group(P<005). The time of vaginal bleeding and the recovery of menstruation were significantly shorter in the observation group than in the control group(P<005). After the operation, the lesions were not found in the observation group, while the mean disappearance time of the control group was (2483 ± 716) d. The cost of hospitalization were less and hospital stay shorter in the observation group than in the control group(P<005).Conclusion Vaginal CSP tissue clearance has equivalent effect with UAE combined with curettage, with shorter operation time, promote rapid recovery of β-HCG, and improve the physiological and social aspects of patients better.It is an effective surgical operation.

参考文献/References:

［1］胡乔飞，李长东，陈素文，等.不同手术方式治疗剖宫产瘢痕妊娠术后人绒毛膜促性腺激素的变化趋势 ［J］.中华医学杂志，2016，96（29）：2332-2335. ［2］陈毅，谢春明，杨敏玲，等.子宫动脉栓塞术在剖宫产术后子宫瘢痕妊娠治疗中的应用 ［J］.介入放射学杂志，2012，21（5）：410-413. ［3］TIMOR-TRITSCH I E,MONTEAGUDO A,CALI G,et al.Cesarean scar pregnancy and early placenta accreta share common histology ［J］.Ultrasound in Obstetrics & Gynecology, 2014, 43(4): 383-395. ［4］骆亚平，王彦龙，杨丽.宫腹腔镜联合诊治剖宫产术后子宫瘢痕妊娠8例临床分析 ［J］.实用妇产科杂志，2012，28（12）：1070-1071. ［5］中华医学会计划生育学分会.剖宫产瘢痕妊娠诊断与治疗共识 ［J］.中华医学杂志，2012，92 （25）：1731-1733. ［6］段丽芬，徐虹，何萍，等.经阴道彩色多普勒超声在剖宫产术后子宫瘢痕妊娠诊治的应用 ［J］.中国临床医学影像杂志，2014，25（4）：260-262. ［7］李燕娜，魏炜，张军.腹腔镜在治疗剖宫产后子宫瘢痕妊娠中的应用 ［J］.实用妇产科杂志，2012，28（4）：285-287. ［8］赵新玲，范造锋，白玉.宫、腹腔镜治疗剖宫产瘢痕妊娠21例临床分析 ［J］.中国微创外科杂志，2016，16（3）：259-262. ［9］JAIN S, SUNEJA A, MALIK R, et al.Cesarean scar pregnancy: a diagnostic dilemma and impending catastrophe ［J］.Archives of Gynecology and Obstetrics, 2014, 289(1): 221-222. ［10］WANG Guangwei, LIU Xiaofei, BI Fangfang, et al.Evaluation of the efficacy of laparoscopic resection for the management of exogenous cesarean scar pregnancy ［J］.Fertility and Sterility, 2014, 101(5): 1501-1507. ［11］李源，向阳，万希润，等.包块型剖宫产术后子宫瘢痕妊娠39例临床分析 ［J］.中华妇产科杂志，2014，49 （1）：10-13. ［12］周应芳，杨慧霞.重视剖宫产术后子宫瘢痕妊娠的预防和处置 ［J］.中华妇产科杂志，2014，49 （1）：3-5. ［13］李瑾瑾，刘欣燕.剖宫产瘢痕妊娠的治疗选择 ［J］.中国医学科学院学报，2014，36 （2）：209-213. ［14］王文芳，陈秀慧，王德莹，等.宫腔镜联合子宫动脉栓塞术在剖宫产切口瘢痕妊娠中应用的可行性分析 ［J］.实用妇产科杂志，2013，29（11）：840-843. ［15］李娟，干晓琴，林海，等.宫腔镜下清宫术治疗剖宫产瘢痕妊娠前不同预处理方式的疗效分析 ［J］.实用妇产科杂志，2016，32（9）：705-708. ［16］刘心.病灶清除术在经阴道剖宫产瘢痕妊娠与经腹腔镜剖宫产瘢痕妊娠中的疗效比较 ［J］.实用临床医药杂志，2016，20（7）：142, 153.

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更新日期/Last Update: 2017-11-25