不同术式治疗剖宫产瘢痕妊娠临床结局及并发症

目的:探讨不同治疗方式对剖宫产瘢痕妊娠(CSP)临床结局及并发症影响。方法:回顾性分析本院2016年8月30日—2018年8月30日收治的102例CSP患者临床资料,其中子宫动脉栓塞联合宫腔镜病灶切除术40例(联合术组),宫腔镜病灶切除术32例(宫腔镜组),腹腔镜治疗30例(腹腔镜组)。分析3组手术相关指标、术后并发症情况,随访至2019年5月30日,观察3组妊娠结局。结果:宫腔镜组胚囊直径小于另外两组,腹腔镜组以Ⅲ型CSP患者为主,宫腔镜组以Ⅰ型CSP为主,联合组以Ⅱ型CSP为主。腹腔镜组手术时间、术中出血量及总并发症发生率均高于另外两组(P<0.05)。术后持续出血时间、中转开腹手术、子宫穿孔发生率、大出血发生率、术后感染发生率3组无差异(P>0.05)。术后60例有生育要求,随访中位时间19个月,自然妊娠率为65.0%,联合术组(15/22)、宫腔镜组(14/20)、腹腔镜组(10/18)比较无差异(P>0.05)。再次CSP发生率为17.9%(7/39),联合术组(3/15)、宫腔镜组(3/14)、腹腔镜组(1/10)比较无差异(P>0.05)。成功分娩联合术组9例(9/15)、宫腔镜组9例(9/14)、腹腔镜组7例(7/10)比较无差异(P>0.05)。3组成功分娩产妇均无严重围产期不良结局。结论:3种手术治疗CSP均具有较好的自然妊娠率、成功分娩率及围产期结局。腹腔镜手术多用于Ⅲ型CSP患者,并发症发生率略高。

Clinical outcomes and complications of different surgical procedure for treating women with cesarean scar pregnancy

Objective:To investigate the clinical outcomes and complications of different surgical procedure for treating women with cesarean scar pregnancy(CSP).Methods:The data of 102 women with CSP from August 30,2016 to August 30,2018 were analyzed retrospectively,which included 40 women in group A were treated by uterine artery embolization combined with hysteroscopy lesion resection,32 women in group B were treated by hysteroscopy lesion resection,and 30 women in group C were treated by laparoscopy lesion resection.The level of surgical related indexes and postoperative complications situation of women in the three groups were analyzed,and the pregnancy outcomes of all women were followed up until May 30,2019.Results:The diameter of blastocysts of women in group B was significant smaller than that of women in group A or group C.The women in group C had mainly type III CSP,the women in group B had mainly type I CSP,and the women in group A had mainly type II CSP.The operation time,intraoperative blood loss,and total complication rate of women in group C were significant more than those of women in group A and group B(P<0.05).There were no significant different in the duration of postoperative continuous bleeding,the rate of conversion to open surgery,incidence of uterine perforation,the rate of profuse bleeding,and rate of postoperative infection of women among the 3 groups(P>0.05).A total of 60 women had fertility requirements after surgery(22 women in group A,20 women in group B,and 18 women in group C).The median follow-up time was 19 months.The natural pregnancy rate of these 60 women was 65.0%,and that of women in group A,B,and C were 15/22,14/20,and 10/18,respectively,which had no significant difference among the three groups(P>0.05).The incidence of CSP again of all women were 17.9%(7/39),and the incidence of CSP again of women in group A,B,and C were 3/15,3/14,and 1/10,respectively,which had no significant difference among the three groups(P>0.05).The success rate of delivery of women in group A,B,and C were 9/15,9/14,and 7/10,respectively,which had no significant difference among the three groups(P>0.05).There was no significant difference in serious adverse perinatal outcomes among the 3 groups.Conclusion:Uterine artery embolization combined with hysteroscopy lesion resection,hysteroscopy lesion resection,and laparoscopy lesion resection for treating women with cesarean scar pregnancy all have high rates of natural pregnancy and success delivery,and also have less adverse perinatal outcomes.Laparoscopy lesion resection for treating women with type III CSP has a higher incidence of complication.