剖宫产切口瘢痕妊娠(CSP)子宫动脉栓塞(UAE)后宫腹腔镜联合手术和刮宫术的比较

 目的  为探索对剖宫产切口瘢痕妊娠(caeasrean scar pregnancy,CSP)更安全有效的治疗措施,本研究对子宫动脉栓塞(uterine artery embolization,UAF)宫腹腔镜联合手术与刮宫术进行比较。方法 自2004年3月至2010年8月,从3个临床中心收集患者58例,分为研究组(MTX动脉内注射+UAE+宫腹腔镜联合手术)25例和对照组(MTX动脉内注射+UAE+刮宫术)33例。对两组患者的一般情况、单次手术清除率,术中并发症(大量出血、子宫破裂)、手术时间、住院时间和术后恢复情况进行统计学分析。结果  研究组患者单次手术清除率为100%,术中平均出血量78.0 mL。对照组除1例因子宫穿孔行全子宫切除外,其余经单次或多次刮宫术后获治,单次手术清除率为82% (P=0.024),平均累计出血量258.5 mL (P=0.004),差异有统计学意义。住院时间方面,研究组平均为6.5天,对照组为8.7天,差异有统计学意义(P=0.043)。血β hCG恢复正常时间方面,研究组平均为19.6天,对照组为29.3天,差异有统计学意义(P=0.033)。术后生活质量方面,研究组患者的下腹疼痛、术后阴道流血和月经恢复情况均显著优于对照组。结论  作为CSP双侧UAE术后的一种后继治疗措施,宫腹腔镜联合手术安全有效。

Comparison of two treatment methods following uterine artery embolization (UAE) in patients with caesarean scar pregnancy (CSP):laparoscopy/hysteroscopy combined surgery versus uterine curettage

Objective  To find more safer and effective treatment methods for caesarean scar pregnancy (CSP) after uterine artery embolization (UAE),we compared laparoscopy and hysteroscopy combined surgery with uterine curettage.Methods  Fifty-eight patients were enrolled from three medical centers in Shanghai,China from Mar.2004 through Aug.2010,who were divided into two cohorts:25 received intra arterial methotrexate (MTX)+UAE+laparoscopy and hysteroscopy
combined surgery (research group),and 33 received intra-arterial methotrexate (MTX)+UAE+uterine curettage (control group).The baseline characters,surgical clearance rates,complications,operation times,durations of hospitalization and recovery qualities of patients from these two groups were compared.Results   The first time clearance rate of the patients in the research group reached 100%,while the mean blood loss during operation was 78.0 mL.The patients in the control group were cured with single or multiple uterine curettages except for one case whose uterus was removed due to the uterine perforation.The first time clearance rate was 82% (P=0.024) and the mean blood loss was 258.5 mL (P=0.004) in the control group,which were both significantly inferior to those of the research group.On the hospital stay and β hCG regression time,the research group was much better than the control group (P=0.43 and P=0.033,respectively).On the post surgical recovery qualities,the patients from the research group had significantly lower rates of abnormal abdominal pain,vaginal bleeding and menstruation compared with those of the control group.Conclusions  As a successive medical measure following the UAE in the treatment of CSP,the safety,effectiveness and therapeutic radicalness of the laparoscopy and hysteroscopy-combined surgery are much higher than those of the traditional uterine curettage,indicating it can be used a routine scenario in the clinic.