双侧子宫动脉栓塞后清宫术与阴式子宫瘢痕妊娠病灶清除联合子宫修补术对患者生活质量影响

目的:探讨双侧子宫动脉栓塞后清宫术(栓塞术)与阴式子宫瘢痕妊娠病灶清除术联合子宫修补术(修补术)对子宫瘢痕妊娠患者生活质量影响。方法:收集本院2017年3月-2018年5月收治的子宫瘢痕妊娠患者61例,基于随机对照原则分组,栓塞组26例,修补组35例,比较两组手术情况及血清β-绒毛膜促性腺激素(β-hCG)水平、转阴时间,月经复潮时间;生活质量测定量表(WHOQOL-BREF)评价患者术后生活质量。结果:栓塞组手术耗时、术中失血量少于修补组,术后阴道流血时间、住院时间、医疗费用高于修补组(均P<0.05);修补组术后24h血清β-hCG降低水平优于栓塞组,β-hCG转阴时间、月经复潮时间均短于栓塞组,术后3个月生理与社会关系领域评分低于栓塞组(均P<0.05),心理、环境领域评分及术后6个月WHOQOL-BREF各领域评分两组均无差异(P>0.05)。结论:双侧子宫动脉栓塞后清宫术与阴式子宫瘢痕妊娠病灶清除术联合子宫修补术治疗CSP均有良好效果,且保留生育功能,安全性高,但修补治疗周期短、费用低,栓塞术式在术后恢复及生活质量改善方面具优势。

Effect of curettage after bilateral uterine artery embolism or vaginal uterine scar pregnancy lesion removal combined with uterine repaired on quality of life of patients with uterine scar pregnancy

Objective:To investigate the effect curettage after bilateral uterine artery embolism(UAE)or vaginal uterine scar pregnancy lesion removal combined with uterine repaired on quality of life of patients with uterine scar pregnancy.Methods:From March 2017 to May 2018,61 patients with uterine scar pregnancy were enrolled in this study.Based on the principle of randomized controlled trial(RCT)and the willingness patients,these patients were divided into group A(26 women were given curettage after bilateral UAE)and group B(35 women were given vaginal uterine scar pregnancy lesion removal combined with uterine repaired).The operation situation,serum level ofβ-human chorionic gonadotropin(β-hCG),time ofβ-hCG returned negative,menstrual recovered time of women were compared between the two groups.The postoperative quality of life of patients was evaluated by World Health Organization Quality of Life scale(WHOQOL-BREF).Results:The operation time and blood loss of women in group A were significant lower than those of women in group B,but the vaginal bleeding time,hospitalization time after operation,and costs of treatment of women in group A were significant higher(all P<0.05).The degree of serumβ-hCG level decreased of women 24 h after operation in group B was better than that of women in group A(P<0.05).The negative conversion time ofβ-hCG,the time of menstruation recover,and the related to physiological and social scores 3 months after operation of women in group A were significant less than those of women in group B(all P<0.05).There were no significant difference in psychology environmental domain score of women 3 months after operation and WHOQOL-BREF score 6 months after operation between the two groups.Conclusion:Curettage after bilateral UAE for treating uterine scar pregnancy has the same effective of vaginal uterine scar pregnancy lesion removal combined with uterine repaired,both can preserve the fertility function with high safety.The treatment time of vaginal uterine scar pregnancy lesion removal combined with uterine repaired is short and the cost is low,but curettage after bilateral has a slight advantage in the choice of repregnancy time and the improvement of quality of life after operation.