CAJ | 학술논문

目的：探讨腹腔镜双侧子宫动脉阻断术结合清宫术治疗子宫瘢痕妊娠（cesarean scar pregnancy，CSP）的临床疗效。方法：回顾性分析2011年1月—2014年1月就诊于保定市第一中心医院的剖宫产术后CSP的60例患者临床资料，将其按治疗方法分为介入组和腹腔镜组，其中介入组（30例）患者先行介入子宫动脉栓塞术，再行超声引导下清宫术，腹腔镜组（30例）患者行腹腔镜双侧子宫动脉阻断术后再行清宫术，比较2组人绒毛膜促性腺激素（hCG）下降至正常的时间、术中出血量、术后不良反应发生率等。结果：2组手术时间，术后月经复潮时间比较差异无统计学意义（P＞0.05），而腹腔镜组术中出血量、血hCG下降至正常的时间和总住院费用均低于介入组，差异均有统计学意义（P＜0.05）。腹腔镜组腹痛、高热和白细胞升高的发生率均低于介入组，差异有统计学意义（P＜0.05），而2组恶心、呕吐等消化道反应的发生率差异无统计学意义（P＞0.05）。结论：腹腔镜双侧子宫动脉阻断术结合清宫术治疗剖宫产术后CSP，治疗效果满意、安全有效，是一种较理想的治疗方法。
목적：탐토복강경쌍측자궁동맥조단술결합청궁술치료자궁반흔임신（cesarean scar pregnancy，CSP）적림상료효。방법：회고성분석2011년1월—2014년1월취진우보정시제일중심의원적부궁산술후CSP적60례환자림상자료，장기안치료방법분위개입조화복강경조，기중개입조（30례）환자선행개입자궁동맥전새술，재행초성인도하청궁술，복강경조（30례）환자행복강경쌍측자궁동맥조단술후재행청궁술，비교2조인융모막촉성선격소（hCG）하강지정상적시간、술중출혈량、술후불량반응발생솔등。결과：2조수술시간，술후월경복조시간비교차이무통계학의의（P＞0.05），이복강경조술중출혈량、혈hCG하강지정상적시간화총주원비용균저우개입조，차이균유통계학의의（P＜0.05）。복강경조복통、고열화백세포승고적발생솔균저우개입조，차이유통계학의의（P＜0.05），이2조악심、구토등소화도반응적발생솔차이무통계학의의（P＞0.05）。결론：복강경쌍측자궁동맥조단술결합청궁술치료부궁산술후CSP，치료효과만의、안전유효，시일충교이상적치료방법。
Objective: To discuss the treatment of cesarean scar pregnancy (CSP) by the laparoscopic uterine arteries ligation combined with uterine curetlage. Methods:Sixty cases with CSP were retrospectively analyzed from January 2011 to January 2014 in our hospital. The cases were divided into two groups depending on different treatments: patients in the interventional therapy group (n=30)accepted bilateral uterine artery embolization,patients in the laparoscopic operation group (n=30)were treated by laparoscopy. When the uterine arteries were blocked by interventional or laparoscopic method,the uterine curettage under ultrasonic guidance was completed. The curative effects were compared, including the length of time of hCG descending to normal ,the intraoperative bleeding volume and the postoperative adverse reaction. Results:There were not significant differences in the operative time and the postoperative period of menses return between two groups (P>0.05). The blood loss,the time of hCG restored to normal range and the total hospital costs in the laparoscopic operation group were significantly lower than those in the interventional therapy group (P<0.05). The incidences of abdominal pain,fever and leukocytosis in the laparoscopic operation group were also significantly lower (P<0.05). However, there were not significant differences in the incidences of nausea, vomiting and other gastrointestinal reactions between the two groups (P>0.05). Conclusions:The laparoscopic uterine arteries ligation combined with uterine curettage is one of good treatments of CSP with its safety and efficiency.