生殖医学杂志

目的观察经阴道局部病灶清除术联合子宫壁修补术治疗瘢痕妊娠的临床疗效。方法选择2016年9月至2018年9月我院收治的114例剖宫产术后瘢痕妊娠患者为研究对象,随机分为2组,各57例,其中对照组予以甲氨喋呤化疗联合清宫术治疗,观察组行经阴道局部病灶清除术联合子宫壁修补术治疗。对比两组术中及术后基本情况,观察治疗后第1、4、7、14d时血清β-HCG水平变化情况,并统计并发症发生情况。结果观察组术后月经复潮时间、术后病灶缩小时间和住院时间分别为(30.52±4.63)d、(5.18±1.32)d和(4.72±1.12)d,均显著短于对照组[分别为(58.05±7.52)d、(8.76±2.02)d和(7.70±1.85)d](P<0.05);观察组术中出血量为(68.12±14.56)ml,显著低于对照组的(86.09±16.10)ml(P<0.05);观察组手术时间、术后子宫下段肌层厚度分别为(42.71±3.25)min、(4.97±0.54)mm,显著高于对照组的(19.26±3.56)min、(2.24±0.36)mm,差异均有统计学意义(P<0.05)。观察组治疗后1、4、7、14d时血清β-HCG下降率分别为(48.57±4.62)%、(69.17±5.24)%、(90.10±8.02)%、(98.65±7.94)%,均显著高于同时段对照组的下降率[分别为(17.16±3.40)%、(53.16±6.03)%、(78.13±7.96)%、(92.28±6.15)%,P<0.05)]。观察组并发症发生率显著低于对照组(10.52%vs.28.07%,P<0.05)。结论经阴道局部病灶清除术联合子宫壁修补术治疗瘢痕妊娠临床疗效确切,能有效改善患者血清β-HCG水平,安全性高。

Objective:To observe the clinical effect of transvaginal local lesion clearance combined with uterine wall repair in treatment of scar pregnancy.Methods:A total of 114 patients with scar pregnancy after cesarean section were enrolled in our hospital from September 2016 to September 2018.The patients were randomly divided into 2 groups,57 patients for each group.The patients in control group were treated with methotrexate chemotherapy combined with uterine curettage,and the patients in observation group were treated with transvaginal local lesion clearance combined with uterine repairment.The basic conditions of the two groups during and after surgery were compared,and the changes of serumβ-HCG on day 1,4,7 and 14 after treatment were observed,and the complications were counted.Results:The time of menses return,the time of lesion reduction and the time of hospitalization in the observation group were(30.52±4.63),(5.18±1.32)and(4.72±1.12)days respectively,which were significantly shorter than those in the control group[(58.05 ±7.52)days,(8.76±2.02)days and(7.70±1.85)days](P<0.05).The amount of bleeding in observation group[(68.12±14.56)vs.(86.09±16.10)ml]was significantly lower than that in the control group(P<0.05).The operation time[(42.71±3.25)vs.(19.26±3.56)min]and the thickness of lower uterine muscle layer[(4.97±0.54)vs.(2.24±0.36)mm]in the observation group were significantly higher than those in the control group(P<0.05).The serum beta HCG decline rate on day 1,4,7,14 was(48.57±4.62)%,(69.17±5.24)%,(90.10±8.02)%,(98.65±7.94)%respectively,which was significantly higher than that of control group [(17.16±3.40)%,(53.16±6.03)%,(78.13±7.96)%,(92.28±6.15)%](P<0.05).The incidence of complications in observation group was significantly lower than that in control group(10.52% vs.28.07%,P<0.05).Conclusions:Transvaginal local lesion clearance combined with uterine wall repair in the treatment of scar pregnancy has a definite clinical effect,which can effectively improve the level of serum beta-HCG and has high safety.