阴式子宫瘢痕妊娠切除疗效及相关因素分析

目的：对阴式子宫瘢痕妊娠切除术与子宫动脉栓塞介入配合清宫术对于剖宫产疤痕部位妊娠（CSP）的治疗效果及相关因素进行比较分析。方法比较阴式子宫瘢痕妊娠切除术患者（治疗组）与子宫动脉栓塞配合清宫术患者（对照组）的术后阴道流血量、术后疤痕持续妊娠率及平均住院时间，并对孕周、剖宫产次数、血绒毛膜促性腺激素（HCG）值、B 超提示的包块大小及是否为活胎这5个因素与手术治疗成功与否的关系进行探讨。结果治疗组患者的术后阴道流血量为（85．38±13．27）mL ，术后疤痕持续妊娠率为2．56％，平均住院时间为（5．13±0．77）d ，与对照组的（163．11±34．87）mL 、11．90％、（8．12±1．88）d 比较明显降低，差异有统计学意义（P＜0．05）；血 HCG 值、B 超包块大小及活胎与手术治疗成功与否有关（P＜0．05），而剖宫产次数和孕周与手术治疗成功与否无明显关系（P＞0．05）。结论阴式子宫瘢痕妊娠切除术出血量少且住院时间短；可有效降低血 HCG 值较高，活胎且包块体积较大的患者术后持续疤痕妊娠发生率。

Efficacy of transvaginal cesarean scar pregnancy debridement surgery and the analysis of related factors

Objective Compare the efficacy of transvaginal cesarean scar pregnancy debridement surgery(treatment group) and the uterine artery embolization company with the curettage(control group) in the treatment of cesarean scar pregnancy and ana-lyze the related factors of the failure of the surgery .Methods Postoperative vaginal bleeding ,incidence of postoperative scar preg-nancy again ,and time of hospital stays after surgery were compared in two groups .Relationships between gestational age ,cesarean section ,the value of serum HCG ,B-mass size ,live births and surgical success rate were discussed .Results The mean amount of blood bleeding during operation of the treatment group was(85 .38 ± 13 .27)mL ,the rate of continue pregnancy after surgery was 2 .56% ,mean time of hospital stays was(5 .13 ± 0 .77)d ,Significantly lower than the control group[(163 .11 ± 34 .87)mL ,11 .90% , (8 .12 ± 1 .88)d ,all P< 0 .05] ;Blood HCG value ,B-mass size ,and live births were related with surgical success rate(P< 0 .05) ,But times of cesarean section and gestational age had no significant relationship with the surgical success rate(P> 0 .05) .Conclusion Tansvaginal cesarean scar pregnancy debridement surgery showed less damage on the treatment of cesarean scar pregnancy ,and re-duced the recurrence rate of the patient ,who had high blood HCG levels ,embryo survival and larger volume .