剖宫产瘢痕妊娠两种手术治疗方式安全性及有效性的比较

目的比较开腹剖宫产瘢痕妊娠病灶切除联合子宫下段修补术和双侧子宫动脉栓塞联合清宫术两种治疗方式在剖宫产瘢痕妊娠治疗中的安全性和有效性。方法选择2009~2014年就诊于北京协和医院并接受手术治疗的剖宫产瘢痕妊娠患者245例,将符合本研究纳入标准的100例患者随机分为开腹剖宫产瘢痕妊娠病灶切除联合子宫下段修补术组(开腹组)和双侧子宫动脉栓塞联合清宫术组(栓塞后清宫组)。收集患者的基本信息、围术期资料及门诊随诊资料,并进行统计学分析。结果两种治疗方法的成功率比较无显著性差异(98.0%vs.96.0%,P0.05)。开腹组患者术中出血量显著多于栓塞后清宫组(95.0±48.4)ml vs.(23.0±17.6)ml](P=0.000)。开腹组患者术后血清β-HCG降至正常所需时间显著短于栓塞后清宫组(30.7±10.7)d vs.(34.7±9.6)d](P0.05)。术后子宫下段前壁剖宫产瘢痕处异常回声消失的时间两组比较无显著性差异(35.7±10.8)d vs.(24.4±13.6)d](P0.05)。开腹组手术时间显著长于栓塞后清宫组(77.0±15.0)min vs.(30.0±16.0)min](P=0.00)。开腹组患者的住院治疗费用显著低于栓塞后清宫组(7 919.6±3 680.6)元vs.(15 285.6±2 962.9)元](P=0.00)。电话随访两组患者术后月经复潮的时间,开腹组显著短于栓塞后清宫组(37.4±8.9)d vs.(40.9±7.2)d](P0.05)。结论开腹剖宫产瘢痕妊娠病灶切除联合子宫下段修补术和双侧子宫动脉栓塞联合清宫术各有优点,均为安全、有效的剖宫产瘢痕妊娠治疗方案。

Comparison of efficacy and safety of two surgical treatments for cesarean scar pregnancy

Objective:To compare the efficacy and safety of hysterotomy by laparotomy combined with repair of lower uterine segment and uterine artery embolization combined with dilation and curettage for the surgical treatment of cesarean scar pregnancy.Methods:A total of 245 patients with cesarean scar pregnancy received treatment in Peking Union Medical College Hospital from 2009 to 2014.Among them,100 patients who met the inclusion criteria of our study were randomly divided into two groups according to their treatment:The patients in group A received hysterotomy by laparotomy combined with repair of the lower uterine segment.The patients in group B received uterine artery embolization combined with dilation and curettage.The basic information,perioperative data and follow-up data of the 100 patients were collected and analyzed.Results:The overall cure rate (98.0％ vs.96.0％) was not significantly different between group A and group B (P＞0.05).The amount of intraoperative bleeding in group B were significantly lower than that in group A (95.0±48.4) ml vs.(23.0±17.6) ml] (P=0.000).The median time for serum β-HCG remission after treatment in group A were significantly less than that in group B (30.7±10.7) vs.(34.7±9.6) days] (P＜0.05).No significant difference was found in the median time for uterine mass disappearance after treatment between two groups (35.7± 10.8) vs.(24.4± 13.6) days] (P＞0.05).The median operation time was significantly longer in group A than that in group B (77.0±15.0) vs.(30.0±16.0) min)] (P=0.00).The median hospitalization cost in group A was significantly lower than that in group B (7 919.6±3 680.6)vs.(15 285.6±2 962.9) RMB] (P=0.00).The median time of menstruation after treatment by telephone follow up was significantly shorter in group A than that in group B (37.4±10.5) vs.(41.2±13.8) days] (P＜0.05).Conclusions:Hysterotomy by laparotomy combined with repair of the lower uterine segment and uterine artery embolization combined with dilation and curettage are both safe and effective treatment for cesarean scar pregnancy.