剖宫产术后子宫瘢痕妊娠的3种治疗方法效果比较

作者单位:114100 辽宁 鞍山,鞍山市台安县恩良医院妇产科

 子宫瘢痕妊娠;剖宫产;术后;治疗;子宫动脉栓塞术;经阴道妊娠物清除;子宫瘢痕修补术;清宫术

Comparison of Three Therapeutic Methods for Cesarean Scar Pregnancy After Cesarean Section
WU Pengying

(Department of Obstetrics and Gynecology, Tai’an Enliang Hospital, Anshan 114100, Liaoning Province, China)

 Uterine Scar Pregnancy; Cesarean Section; Postoperative; Treatment; Uterine Artery Embolization; Vaginal Pregnancy Clearance; Uterine Scar Repair; Uterine Curettage

DOI: 10.3969/j.issn.1672-7185.2019.11.021

备注

 目的  比较3种方法治疗剖宫产术后子宫瘢痕妊娠的效果。方法  选择2017年1月—2018年12月台安县恩良医院收治的50例剖宫产术后子宫瘢痕妊娠患者进行临床研究,根据个人意愿及是否满足相关治疗适应证分为三组,栓塞组18例在B超引导下行子宫动脉栓塞联合清宫术治疗;修复组16例经引导行妊娠物清除联合子宫瘢痕修补;药物组16例在口服甲氨蝶呤联合米非司酮杀胚后行清宫术。比较3种治疗方法的效果。结果  三组术中出血量、术后阴道流血时间、抗生素使用时间、住院时间比较,差异均有统计学意义(P<0.05),栓塞组术中出血量、术后阴道流血时间、抗生素使用时间、住院时间少于修复组和药物组,而药物组手术时间最短。三组均未见严重并发症发生,均于术后2个月内月经恢复正常。结论  对于剖宫产术后子宫瘢痕妊娠的治疗,子宫动脉栓塞联合在B超引导下清宫术,微创安全,但有妊娠需求者谨慎选择;经阴道妊娠物清除联合子宫瘢痕修补术根治性强,但手术风险较高;药物杀胚后在B超引导下行清宫术,微创安全,但患者住院时间较长。对于剖宫产术后子宫瘢痕妊娠的治疗,应结合患者病情及不同生育需求制定个体化治疗方案。
Objective To compare three methods in treating cesarean scar pregnancy after cesarean section. Methods  A total of 50 cases of cesarean scar pregnancy after cesarean section in Tai’an Enliang Hospital from January 2017 to December 2018 were selected for clinical study. They were divided into three groups according to their personal wishes and whether they met the relevant treatment indications. In the embolization group, 18 cases were treated by uterine artery embolization combined with uterine curettage under the guidance of B-ultrasound. In the repair group, pregnancy clearance and uterine scar repair were guided in 16 cases. The 16 cases in drug group underwent uterine curettage after oral methotrexate combined with mifepristone killing embryos. Comparing the effects of three treatments. Results  The amount of bleeding during operation, the time of vaginal bleeding after operation, the time of using antibiotics and the time of hospitalization were significantly different(P<0.05). The amount of bleeding during operation, the time of vaginal bleeding after operation, the time of using antibiotics and the time of hospitalization in the embolization group were less than those in the repair group and the drug group, while the operation time in the drug group was the shortest. No serious complications occurred in all three groups, and menstruation returned to normal within 2 months after operation. Conclusion  For the treatment of cesarean scar pregnancy after cesarean section, uterine artery embolization combined with B-ultrasound-guided uterine curettage is minimally invasive and safe, but those who need pregnancy are cautious to choose. Vaginal pregnancy clearance and uterine scar repair are radical, but the risk of operation is high. After drug killing embryos, uterine curettage under B-ultrasound-guided is minimally invasive and safe, but the patient stayed in hospital for a long time. For the treatment of cesarean scar pregnancy after cesarean section, individualized treatment should be formulated according to the patient’s condition and different fertility needs.