不同子宫肌壁厚度剖宫产瘢痕妊娠行B超引导下清宫的效果观察(1)
【摘要】 目的 了解不同子宮肌壁厚度剖宫产瘢痕妊娠(CSP)行B超引导下清宫的效果。方法 128例CSP孕妇， 将瘢痕处子宫肌壁厚度>4 mm孕妇设为A组(54例)、瘢痕处肌壁厚度2～4 mm且血绒毛膜促性腺激素(HCG)≤8000 U/L设为B组(36例)、瘢痕处肌壁厚度2～4 mm且血HCG>8000 U/L设为C组(38例)。A组和B组均直接进行B超引导下清宫， C组进行子宫动脉栓塞术(UAE)后再行B超引导下清宫。比较三组的手术时间、术中出血量、血HCG转正常时间及术后妊娠组织残留率、瘢痕处血肿发生率。结果 三组手术时间比较差异无统计学意义(P>0.05);B组的术中出血量(19.65±1.73)ml多于A组的(7.26±0.83)ml和C组的(6.15±0.57)ml， 差异有统计学意义(P<0.05);B组血HCG转正常时间(36.15±2.69)d长于A组的(22.59±1.73)d和C组的(21.68±2.49)d， 差异有统计学意义(P<0.05);三组妊娠组织残留率和瘢痕处血肿发生率比较差异无统计学意义(P>0.05)。结论 瘢痕处子宫肌壁厚度2～4 mm且血HCG≤8000 U/L的CSP直接行B超引导下清宫由于手术并发症增加需慎重选择， 其中有再生育要求者不作为首选措施。瘢痕处子宫肌壁厚度2～4 mm且血HCG>8000 U/L的CSP行子宫动脉栓塞术后行B超引导下清宫由于住院费用高、术后瘢痕缺陷持续存在、子宫动脉栓塞术并发症及受医院条件限制等缺点， 对有再生育要求者不推荐作为首选措施。
【关键词】 剖宫产;瘢痕妊娠;子宫肌壁厚度;子宫动脉栓塞术;清宫
DOI：10.14163/j.cnki.11-5547/r.2020.17.012
【Abstract】 Objective To understand the effect of dilatation and curettage under the guidance of B-ultrasound in cesarean scar pregnancy (CSP) with different uterine muscle wall thickness. Methods Among 128 pregnant women with CSP， pregnant women with uterine muscle wall thickness >4 mm in scars were set as group A (54 cases)， pregnant women with muscle wall thickness in scars was 2-4 mm， and human chorionic gonadotropin (HCG) ≤8000 U/L set as group B (36 cases)， pregnant women with muscle wall thickness in scars was 2-4 mm， and HCG >8000 U/L set as group C (38 cases). Group A and group B received dilatation and curettage under the guidance of B-ultrasound， and group C received uterine artery embolization (UAE) before ilatation and curettage under the guidance of B-ultrasound. The surgery time， amount of intraoperative hemorrhage， blood HCG return to normal time and the residual rate of postoperative pregnancy tissue and the incidence of hematoma at the scar were compared among the three groups. Results There was no statistically significant difference in surgery time among the three groups (P>0.05). The amount of intraoperative hemorrhage (19.65±1.73) ml of group B was higher than that of group A (7.26±0.83) ml and group C (6.15±0.57) ml， and the difference was statistically significant (P<0.05). The blood HCG return to normal time (36.15±2.69) d of group B was longer than that of group A (22.59±1.73) d and group C (21.68±2.49) d， and the difference was statistically significant (P<0.05). There was no statistically significant difference in residual rate of postoperative pregnancy tissue and the incidence of hematoma at the scar among the three groups (P>0.05). Conclusion The CSP with the thickness of 2-4 mm and the blood HCG ≤ 8000 U/L at the scar should be carefully for dilatation and curettage under the guidance of B-ultrasound due to the increase of surgical complications， especially for those who have the requirement of reproduction. The CSP with thickness of 2-4mm and blood HCG >8000 U/L at the scar can perform uterine artery embolization before ilatation and curettage under the guidance of B-ultrasound. Due to the disadvantages of high hospitalization costs， persistent scar defects after surgery， complications of uterine artery embolization and limited by hospital conditions， it is not recommended as the first measure for those with reproductive requirements., http://www.100md.com(李燕雄 张俊 陈文忠)
【关键词】 剖宫产;瘢痕妊娠;子宫肌壁厚度;子宫动脉栓塞术;清宫
DOI：10.14163/j.cnki.11-5547/r.2020.17.012
【Abstract】 Objective To understand the effect of dilatation and curettage under the guidance of B-ultrasound in cesarean scar pregnancy (CSP) with different uterine muscle wall thickness. Methods Among 128 pregnant women with CSP， pregnant women with uterine muscle wall thickness >4 mm in scars were set as group A (54 cases)， pregnant women with muscle wall thickness in scars was 2-4 mm， and human chorionic gonadotropin (HCG) ≤8000 U/L set as group B (36 cases)， pregnant women with muscle wall thickness in scars was 2-4 mm， and HCG >8000 U/L set as group C (38 cases). Group A and group B received dilatation and curettage under the guidance of B-ultrasound， and group C received uterine artery embolization (UAE) before ilatation and curettage under the guidance of B-ultrasound. The surgery time， amount of intraoperative hemorrhage， blood HCG return to normal time and the residual rate of postoperative pregnancy tissue and the incidence of hematoma at the scar were compared among the three groups. Results There was no statistically significant difference in surgery time among the three groups (P>0.05). The amount of intraoperative hemorrhage (19.65±1.73) ml of group B was higher than that of group A (7.26±0.83) ml and group C (6.15±0.57) ml， and the difference was statistically significant (P<0.05). The blood HCG return to normal time (36.15±2.69) d of group B was longer than that of group A (22.59±1.73) d and group C (21.68±2.49) d， and the difference was statistically significant (P<0.05). There was no statistically significant difference in residual rate of postoperative pregnancy tissue and the incidence of hematoma at the scar among the three groups (P>0.05). Conclusion The CSP with the thickness of 2-4 mm and the blood HCG ≤ 8000 U/L at the scar should be carefully for dilatation and curettage under the guidance of B-ultrasound due to the increase of surgical complications， especially for those who have the requirement of reproduction. The CSP with thickness of 2-4mm and blood HCG >8000 U/L at the scar can perform uterine artery embolization before ilatation and curettage under the guidance of B-ultrasound. Due to the disadvantages of high hospitalization costs， persistent scar defects after surgery， complications of uterine artery embolization and limited by hospital conditions， it is not recommended as the first measure for those with reproductive requirements., http://www.100md.com(李燕雄 张俊 陈文忠)
参见：首页 > 医疗版 > 疾病专题 > 整形外科 > 瘢痕