86例Ⅲ型瘢痕妊娠诊治体会

doi:10.6040/j.issn.1671-7554.0.2020.1058

摘要/Abstract

摘要： 目的探讨Ⅲ型剖宫产瘢痕妊娠(CSP)的治疗方案。方法回顾性分析山东第一医科大学附属省立医院妇科收治的Ⅲ型CSP患者86例,术前依据患者病情风险性的大小采取相应的手术方式。按治疗方法分为3组,A组30例行子宫动脉栓塞后清宫术、B组18例行宫腔镜下胚物清除术、C组38例行宫腔镜联合腹腔镜病灶切除+子宫瘢痕修补术。比较3组患者的孕龄、孕囊长径、瘢痕处肌层厚度、术前血清β人绒毛膜促性腺激素(β-hCG)水平、术中出血量、术后血清β-hCG下降幅度、住院时间和治疗成功率。统计分析中定量数据涉及多组的单因素方差分析或非参数检验,分类数据采用χ2检验。结果 3组患者在年龄、剖宫产次数和距上次剖宫产手术间隔相比较差异具有可比性(P均>0.05)。3组患者孕囊长径、瘢痕处肌层厚度、术前血清β-hCG水平的差异均有统计学意义,两两多重比较显示孕囊长径A组、C组均大于B组(F=52.196,P<0.001);瘢痕处肌层厚度A组和C组低于B组(H=42.553,P<0.001);术前血清β-hCG水平A组和C组高于B组(H=9.173,P=0.010),差异均有统计学意义;而其余两两多重比较均无统计学意义。术中出血量中位数C组较A组和B组多(H=17.211,P<0.001)。手术后A、B、C三组治疗成功率分别为86.67%、88.89%和97.37%,组间比较差异无统计学意义, χ2=3.072,P=0.190。术后血清β-hCG下降幅度C组最快,H=14.238,P=0.001,差异有统计学意义。结论研究观察表明对于孕囊或包块≤3 cm、瘢痕厚度≥2 mm的Ⅲ型CSP可行宫腔镜下胚物清除;孕囊或包块>3 cm、瘢痕厚度<2 mm可优选宫腔镜联合腹腔镜病灶切除+子宫修补术。子宫动脉栓塞术可作为CSP治疗后出血的补充治疗,一般不做预防性使用。

关键词: 瘢痕妊娠, 手术治疗, 子宫动脉栓塞, 宫腔镜, 腹腔镜, 子宫瘢痕修补术

Abstract: Objective To explore the treatment strategy of type Ⅲ cesarean scar pregnancy(CSP). Methods The records of 86 patients with type Ⅲ CSP treated in our hospital in the last decade were retrospectively reviewed. According to the surgical methods, the patients were divided into three groups. Group A(n=30)underwent curettage after uterine artery embolization, group B(n=18)received hysteroscopic curettage, and group C(n=38)received laparoscopy combined with hysteroscopic curettage and uterine scar repair. The gestational age, diameter of gestational sac, myometrium thickness, preoperative serum β-human chorionic gonadotropin(β-hCG)level, intraoperative blood loss, decrease of postoperative serum β-hCG, hospitalization time and success rate were compared among the three groups. The quantitative data involved multiple groups of one-way ANOVA or nonparametric test, and the classified data were analyzed by Chi-square test. Results There were no significant differences in maternal age, cesarean frequency and interval since the last cesarean section among the three groups(P>0.05). Gestational sac diameter was larger in group A and group C than in group B(F=52.196, P<0.001). Myometrium thickness was lower in group A and group C than in group B(H=42.553, P<0.001). Preoperative serum β-hCG was significantly higher in group A and group C than in group B(H=9.173, P=0.010). The other pairwise comparisons had no statistical significance. The median amount of intraoperative blood loss was higher in group C than in group A and group B(H=17.211, P<0.001). The success rate in groups A, B and C was 86.67%, 88.89% and 97.37%, respectively, with no significant difference(χ2=3.072, P=0.190). The mean decrease of postoperative serum β-hCG in group C was the fastest(H=14.238, P=0.001). Conclusion For type Ⅲ CSP with gestational sac or mass ≤3 cm and scar thickness ≥2 mm, hysteroscopic curettage can be selected. For gestational sac or mass >3 cm and scar thickness <2 mm, laparoscopy combined with hysteroscopic curettage is recommended. Uterine artery embolization can be used as a supplementary treatment when massive bleeding occurs after primary treatment instead of a preventive measure before curettage.

Key words: Cesarean scar pregnancy, Surgical treatment, Uterine artery embolization, Hysteroscopy, Laparoscopy, Uterine scar repair

中图分类号:

R714.1

霍素霞,刘薇,王鑫. 86例Ⅲ型瘢痕妊娠诊治体会[J]. 山东大学学报 (医学版), 2021, 59(1): 40-44.

HUO Suxia, LIU Wei, WANG Xin. Experience in the treatment of 86 cases of type Ⅲ cesarean scar pregnancy[J]. Journal of Shandong University (Health Sciences), 2021, 59(1): 40-44.

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