中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2015年
8期
576-581
,共6页
王光伟%刘晓菲%王丹丹%杨清
王光偉%劉曉菲%王丹丹%楊清
왕광위%류효비%왕단단%양청
妊娠,异位%剖宫产术%宫腔镜检查%子宫动脉栓塞术
妊娠,異位%剖宮產術%宮腔鏡檢查%子宮動脈栓塞術
임신,이위%부궁산술%궁강경검사%자궁동맥전새술
Pregnancy,ectopic%Cesarean section%Hysteroscopy%Uterine artery embolization
目的：探讨子宫动脉栓塞术（UAE）联合宫腔镜手术治疗外生型剖宫产术后子宫瘢痕妊娠（CSP）的安全性及应用价值。方法回顾性分析2011年3月至2014年8月中国医科大学附属盛京医院诊治的接受选择性UAE联合宫腔镜手术治疗的67例外生型CSP患者的临床资料，其中35例子宫瘢痕处组织厚度>3 mm（厚度>3 mm组），32例瘢痕处组织厚度≤3 mm（厚度≤3 mm组），比较两组患者的手术时间、术中出血量、术后宫腔引流量、术后住院时间、β-hCG下降至正常时间、术后包块吸收时间等。结果厚度>3 mm组患者宫腔镜手术均成功，其中1例因术后1个月复查彩超提示子宫瘢痕处仍有较大包块且β-hCG下降缓慢，于术后37 d行二次宫腔镜手术成功切除包块。厚度≤3 mm组患者宫腔镜手术中有3例转行腹腔镜或开腹手术，术后有7例患者接受了二次手术。厚度>3 mm组患者宫腔镜手术中出血量为（97±41）ml，厚度≤3 mm组为（161±92）ml，两组比较，差异有统计学意义（P<0.01）。厚度>3 mm组宫腔镜手术时间、术后宫腔引流量、术后住院时间、血清β-hCG下降至正常时间、术后包块吸收时间分别为（36±9）min、（38±13）ml、（3.5±0.5）d、（26±5）d、（82±17）d，厚度≤3 mm组分别为（37±9）min、（42±16）ml、（4.0±0.7）d、（28±8）d、（88±15）d，分别比较，差异均无统计学意义（P>0.05）。结论剖宫产术后子宫瘢痕处组织厚度≤3 mm时，应慎行宫腔镜手术。UAE联合宫腔镜手术治疗子宫瘢痕处组织厚度>3 mm的外生型CSP安全、有一定的可行性，须根据患者情况严格把握适应证，并由经验丰富的宫腔镜医师完成手术。
目的：探討子宮動脈栓塞術（UAE）聯閤宮腔鏡手術治療外生型剖宮產術後子宮瘢痕妊娠（CSP）的安全性及應用價值。方法迴顧性分析2011年3月至2014年8月中國醫科大學附屬盛京醫院診治的接受選擇性UAE聯閤宮腔鏡手術治療的67例外生型CSP患者的臨床資料，其中35例子宮瘢痕處組織厚度>3 mm（厚度>3 mm組），32例瘢痕處組織厚度≤3 mm（厚度≤3 mm組），比較兩組患者的手術時間、術中齣血量、術後宮腔引流量、術後住院時間、β-hCG下降至正常時間、術後包塊吸收時間等。結果厚度>3 mm組患者宮腔鏡手術均成功，其中1例因術後1箇月複查綵超提示子宮瘢痕處仍有較大包塊且β-hCG下降緩慢，于術後37 d行二次宮腔鏡手術成功切除包塊。厚度≤3 mm組患者宮腔鏡手術中有3例轉行腹腔鏡或開腹手術，術後有7例患者接受瞭二次手術。厚度>3 mm組患者宮腔鏡手術中齣血量為（97±41）ml，厚度≤3 mm組為（161±92）ml，兩組比較，差異有統計學意義（P<0.01）。厚度>3 mm組宮腔鏡手術時間、術後宮腔引流量、術後住院時間、血清β-hCG下降至正常時間、術後包塊吸收時間分彆為（36±9）min、（38±13）ml、（3.5±0.5）d、（26±5）d、（82±17）d，厚度≤3 mm組分彆為（37±9）min、（42±16）ml、（4.0±0.7）d、（28±8）d、（88±15）d，分彆比較，差異均無統計學意義（P>0.05）。結論剖宮產術後子宮瘢痕處組織厚度≤3 mm時，應慎行宮腔鏡手術。UAE聯閤宮腔鏡手術治療子宮瘢痕處組織厚度>3 mm的外生型CSP安全、有一定的可行性，鬚根據患者情況嚴格把握適應證，併由經驗豐富的宮腔鏡醫師完成手術。
목적：탐토자궁동맥전새술（UAE）연합궁강경수술치료외생형부궁산술후자궁반흔임신（CSP）적안전성급응용개치。방법회고성분석2011년3월지2014년8월중국의과대학부속성경의원진치적접수선택성UAE연합궁강경수술치료적67예외생형CSP환자적림상자료，기중35례자궁반흔처조직후도>3 mm（후도>3 mm조），32례반흔처조직후도≤3 mm（후도≤3 mm조），비교량조환자적수술시간、술중출혈량、술후궁강인류량、술후주원시간、β-hCG하강지정상시간、술후포괴흡수시간등。결과후도>3 mm조환자궁강경수술균성공，기중1례인술후1개월복사채초제시자궁반흔처잉유교대포괴차β-hCG하강완만，우술후37 d행이차궁강경수술성공절제포괴。후도≤3 mm조환자궁강경수술중유3례전행복강경혹개복수술，술후유7례환자접수료이차수술。후도>3 mm조환자궁강경수술중출혈량위（97±41）ml，후도≤3 mm조위（161±92）ml，량조비교，차이유통계학의의（P<0.01）。후도>3 mm조궁강경수술시간、술후궁강인류량、술후주원시간、혈청β-hCG하강지정상시간、술후포괴흡수시간분별위（36±9）min、（38±13）ml、（3.5±0.5）d、（26±5）d、（82±17）d，후도≤3 mm조분별위（37±9）min、（42±16）ml、（4.0±0.7）d、（28±8）d、（88±15）d，분별비교，차이균무통계학의의（P>0.05）。결론부궁산술후자궁반흔처조직후도≤3 mm시，응신행궁강경수술。UAE연합궁강경수술치료자궁반흔처조직후도>3 mm적외생형CSP안전、유일정적가행성，수근거환자정황엄격파악괄응증，병유경험봉부적궁강경의사완성수술。
Objective To investigate the safety and feasibility of uterine arterial embolization (UAE) combined with hystersocpic excisionl of exogenous cesarean scar pregnancy (CSP). Methods Totally 67 patients with exogenous CSP treated with selective UAE combined with hysterscopic surgery in Shengjing Hospital of China Medical University were analyzed retrospectively; 35 patients in Group A (thickness of the cesarean scar>3 mm), while 32 patients in Group B (thickness of the cesarean scar≤3 mm). The following clinical parameters including operative time, intraoperative blood loss, quantity of postoperative uterine drainage, postoperative hospital days, the time for the mass absorption and the return ofβ-hCG to normal were compared. Results All hysterscopic procedures were successfully completed in Group A, and only one case underwent a second hysteroscopic excision due to the 1-month postoperative ultrasound examination indicating a mass located in the cesarean scar and a slow decline of β-hCG. Three cases of Group B were transformed to laparoscopic or laparotomy operation and 7 cases underwent a second surgery. The volume of introperative blood loss was (97±41) ml in Group A and (161±92) ml in Group B, the difference was statistically significant (P<0.01). But the operative time, quantity of postoperative uterine drainage, postoperative hospital days, the time for the retrun ofβ-hCG to normal and the mass absorption in Group A were (36±9) minutes, (38±13) ml, (3.5±0.5) days, (26±5) days, (82±17) days, in Group B were (37± 9) minutes, (42 ± 16) ml, (4.0 ± 0.7) days, (28 ± 8) days, (88 ± 15) days, respectively, the differences were not statistically significant (all P>0.05). Conclusions For exogenous CSP, when the thickness of cesarean scar is ≤3 mm, whether or not undertaking UAE, it should be seen as contraindication of hysterscopic surgery. UAE combined with hysterscopic surgery for the treatment of exogeous CSP with the cesarean scar thickness>3 mm is safe and feasible according to patients condition and should be performed by experienced hysteroscopist.
