阴式子宫瘢痕妊娠病灶切除+子宫憩室修补术与子宫动脉栓塞术治疗剖宫产瘢痕妊娠的疗效比较
Effect comparison between transvaginal resection combined with uterine diverticulum neoplasty and uterine artery embolization in the treatment of caesarean scar pregnancy
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摘要: 目的：比较阴式子宫瘢痕妊娠病灶切除+子宫憩室修补术与子宫动脉栓塞术对治疗剖宫产瘢痕妊娠（caesarean scar pregnancy，CSP）的疗效。方法：回顾性分析30例CSP患者临床资料，12例行经阴式子宫瘢痕妊娠病灶切除+子宫憩室修补术，18例行子宫动脉栓塞术联合甲氨蝶呤治疗+择期清宫术。比较2种术式的手术时间、术中出血量、术后血β-hCG恢复正常的时间、住院时间、住院费用及并发症的发生情况。结果：2种术式手术时间和住院时间差异均无统计学意义（P>0.05）。12例经阴道子宫下段切开取胚术均手术成功，无明显并发症，术中出血量为 （55.2±15.5）mL，血β-hCG恢复正常时间为（15.8±3.5）d,住院费用为（7 820.5±360.0）元，均明显少于子宫动脉栓塞术各指标（P<0.01）。18例子宫动脉栓塞术中有1例在术后进行清宫术，术中出现瘢痕破裂，急诊行经腹子宫瘢痕妊娠病灶切除及修补。结论：阴式子宫瘢痕妊娠病灶切除+子宫憩室修补术作为治疗CSP的手术方案，是一种损伤小、恢复快、有效、安全、经济的手术方法。Abstract: Objective: To compare the effects of transvaginal resection combined with uterine diverticulum neoplasty and uterine artery embolization in the treatment of caesarean scar pregnancy(CSP).Methods: The data of 30 patients with CSP were retrospectively analyzed.Twelve cases were treated with transvaginal resection combined with uterine diverticulum neoplasty,18 cases were treated with uterine artery embolization,methotrexate combined with curettage.The operative time,peroperative bleeding volume,postoperative recovery time of β-hCG,hospitalization time and cost,and complication between two techniques were compared.Results: The differences of the average operation and hospitalization time were not statistically significant(P>0.05).The taking embryo operation through transvaginal resection of lower uterine segment in 12 cases were successful,and no complication was found.The peroperative bleeding volume,postoperative recovery time of β-hCG,hospitalization cost were(55.2±15.5)mL,(15.8±3.5)d and(7 820.5±360.0) Yuan,respectively,which were less than those in the patients treated with uterine artery embolization(P<0.01).Among 18 cases treated with uterine artery embolization,1 case was treated with curettage.The scar broke during the operation,and which was excised and repaired.Conclusions: The treatment of CSP with the transvaginal resection combined with uterine diverticulum neoplasty is effective,safe,economic and quick recovery.
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