三种不同治疗方案在剖宫产术后子宫瘢痕妊娠中的应用效果(1)
[摘要] 目的 探究三種不同治疗方案在保留剖宫产术后子宫瘢痕妊娠患者生育功能中的应用效果。 方法 回顾性分析河北省石家庄市平山县人民医院2013年11月～2015年11月收治的132例剖宫产术后子宫瘢痕妊娠患者的临床资料，按照手术方法的不同将其分为A组(41例)、B组(36例)、C组(55例)，A组患者实施子宫动脉灌注栓塞术联合清宫术，B组患者采用阴式瘢痕妊娠病灶清除术联合子宫肌壁修补术，C组行腹腔镜下瘢痕妊娠病灶清除术联合子宫肌壁修补术。观察并记录三组手术时间、术中出血量、住院时间；对比术前、术后1 d β-人绒毛膜促性腺激素(β-HCG)水平；并观察阴道流血时间、月经恢复时间、血β-HCG恢复正常时间。 结果 A组手术时间、术中出血量、住院时间分别为(16.24±4.25)min、(17.25±4.36)mL、(8.64±1.06)d，与B组[(57.24±12.24)min、(90.12±26.65)mL、(5.32±1.12)d]和C组[(73.65±11.78)min、(108.45±31.21)mL、(6.54±1.08)d]比较差异有统计学意义(P < 0.05)。三组患者术后β-HCG水平均较术前显著下降(P < 0.05)，A组术后β-HCG水平显著高于B、C组(P < 0.05)。三组患者阴道流血时间、月经恢复时间以及血β-HCG恢复正常时间比较差异有统计学意义(P < 0.05)，其中A组上述时间显著长于B、C组(P < 0.05)。 结论 子宫动脉灌注栓塞术联合清宫术适用于Ⅰ型子宫瘢痕妊娠患者，瘢痕妊娠病灶清除术联合子宫肌壁修补术在保留患者生育功能的同时，可有效清除病灶，且创伤小，恢复快，适用于Ⅱ型子宫瘢痕妊娠患者，值得临床推广。
[关键词] 剖宫产；子宫瘢痕妊娠；生育功能；子宫肌壁修补术；瘢痕妊娠病灶清除术
[中图分类号] R713.4 [文献标识码] A [文章编号] 1673-7210(2016)12(c)-0129-04
[Abstract] Objective To investigate the application effects of three different therapeutic schedules in reserving the fertility function of patients with uterine scar pregnancy after cesarean section. Methods The clinical data of 132 patients with uterine scar pregnancy after cesarean section admitted to Pingshan People's Hospital of Shijiazhuang City from November 2013 to November 2015 was analyzed retrospectively， the patients were divided into group A (41 cases)， group B (36 cases)， group C (55 cases) according to different surgical methods. Group A was taken uterine artery embolization combined with uterine curettage， group B was taken transvaginal cesarean scar pregnancy debridement surgery combined with repair of uterine muscle wall， group C was taken laparoscopic cesarean scar pregnancy debridement surgery combined with repair of uterine muscle wall. The operative time， intraoperative blood loss， hospital stay in the three groups were observed and recorded； the levels of β- human chorionic gonadotropin (β-HCG) before operation and after operation for 1 d were compared； the vagnal bleeding time， menstruation recovery time and the time of β-HCG return to normal was observed. Results The operative time， intraoperative blood loss， hospital stay in group A was (16.24±4.25) min， (17.25±4.36) mL， (8.64±1.06) d respectively， which had significant differences compared with those of group B [(57.24±12.24) min， (90.12±26.65) mL， (5.32±1.12) d] and group C [(73.65±11.78) min， (108.45±31.21) mL， (6.54±1.08) d] (P < 0.05). The levels of β-HCG after operation in the three groups were all significantly lower than those before operation (P < 0.05)， and the level of β-HCG after operation in group A was significantly higher than those of group B and group C (P < 0.05). There were significant differences of vagnal bleeding time， menstruation recovery time and the time of β-HCG return to normal in the three groups (P < 0.05)， the time above in group A was significantly longer than that of group B and group C (P < 0.05). Conclusion Uterine artery embolization combined with uterine curettage is suitable for patients with type Ⅰ uterine scar pregnancy， cesarean scar pregnancy debridement surgery combined with repair of uterine muscle wall can effectively remove the lesions while reserving the fertility function， with small trauma and fast recovery， which is suitable for patients with type Ⅱ uterine scar pregnancy and worthy of clinical promotion., 百拇医药(赵彦婷 刘彦肖 郝国荣)
[关键词] 剖宫产；子宫瘢痕妊娠；生育功能；子宫肌壁修补术；瘢痕妊娠病灶清除术
[中图分类号] R713.4 [文献标识码] A [文章编号] 1673-7210(2016)12(c)-0129-04
[Abstract] Objective To investigate the application effects of three different therapeutic schedules in reserving the fertility function of patients with uterine scar pregnancy after cesarean section. Methods The clinical data of 132 patients with uterine scar pregnancy after cesarean section admitted to Pingshan People's Hospital of Shijiazhuang City from November 2013 to November 2015 was analyzed retrospectively， the patients were divided into group A (41 cases)， group B (36 cases)， group C (55 cases) according to different surgical methods. Group A was taken uterine artery embolization combined with uterine curettage， group B was taken transvaginal cesarean scar pregnancy debridement surgery combined with repair of uterine muscle wall， group C was taken laparoscopic cesarean scar pregnancy debridement surgery combined with repair of uterine muscle wall. The operative time， intraoperative blood loss， hospital stay in the three groups were observed and recorded； the levels of β- human chorionic gonadotropin (β-HCG) before operation and after operation for 1 d were compared； the vagnal bleeding time， menstruation recovery time and the time of β-HCG return to normal was observed. Results The operative time， intraoperative blood loss， hospital stay in group A was (16.24±4.25) min， (17.25±4.36) mL， (8.64±1.06) d respectively， which had significant differences compared with those of group B [(57.24±12.24) min， (90.12±26.65) mL， (5.32±1.12) d] and group C [(73.65±11.78) min， (108.45±31.21) mL， (6.54±1.08) d] (P < 0.05). The levels of β-HCG after operation in the three groups were all significantly lower than those before operation (P < 0.05)， and the level of β-HCG after operation in group A was significantly higher than those of group B and group C (P < 0.05). There were significant differences of vagnal bleeding time， menstruation recovery time and the time of β-HCG return to normal in the three groups (P < 0.05)， the time above in group A was significantly longer than that of group B and group C (P < 0.05). Conclusion Uterine artery embolization combined with uterine curettage is suitable for patients with type Ⅰ uterine scar pregnancy， cesarean scar pregnancy debridement surgery combined with repair of uterine muscle wall can effectively remove the lesions while reserving the fertility function， with small trauma and fast recovery， which is suitable for patients with type Ⅱ uterine scar pregnancy and worthy of clinical promotion., 百拇医药(赵彦婷 刘彦肖 郝国荣)