[1]张海波,赵　玮,马俊英,等.腹腔镜下暂时性子宫动脉结扎术治疗Ⅲ型子宫瘢痕妊娠疗效观察[J].新乡医学院学报,2020,37(9):865-868.[doi:10.7683/xxyxyxb.2020.09.014]
　ZHANG Haibo,ZHAO Wei,MA Junying,et al.Effect of temporary uterine artery ligation under laparoscope in the treatment of type Ⅲ cesarean scar pregnancy[J].Journal of Xinxiang Medical University,2020,37(9):865-868.[doi:10.7683/xxyxyxb.2020.09.014]
点击复制

腹腔镜下暂时性子宫动脉结扎术治疗Ⅲ型子宫瘢痕妊娠疗效观察
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年9
页码:
865-868
栏目:
临床研究
出版日期:
2020-09-05

文章信息/Info

Title:
Effect of temporary uterine artery ligation under laparoscope in the treatment of type Ⅲ cesarean scar pregnancy
作者:
张海波; 赵　玮; 马俊英; 康　山
（河北医科大学第四医院妇科，河北　石家庄　050011）
Author(s):
ZHANG Haibo; ZHAO Wei; MA Junying; KANG Shan
（Department of Gynaecology,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,Hebei Province，China）
关键词:
腹腔镜; 子宫瘢痕妊娠; 子宫动脉栓塞
Keywords:
laparoscope; cesarean scar pregnancy; uterine arterial embolism
分类号:
R714.22
DOI:
10.7683/xxyxyxb.2020.09.014
文献标志码:
A
摘要:
目的　观察腹腔镜下暂时性子宫动脉结扎术治疗Ⅲ型子宫瘢痕妊娠的疗效。方法　选择2016 年1月至2018 年5 月河北医科大学第四医院收治的40例Ⅲ型子宫瘢痕妊娠患者为研究对象。将患者按手术方式分为观察组（n=17）和对照组（n=23）。对照组患者行子宫动脉介入栓塞术+腹腔镜下子宫瘢痕妊娠部位切除及修补术；观察组患者行腹腔镜下子宫动脉暂时性结扎术+子宫瘢痕妊娠部位切除及修补术。比较2组患者术中出血量、手术时间、住院时间、住院费用、术后体温恢复正常（降至37.3 ℃以下）时间、术后宫腔引流量、血清β-人绒毛膜促性腺激素（β-HCG）降至正常时间及术后月经恢复时间。结果　2组患者均成功完成手术。2组患者术中出血量、术后β-HCG恢复正常时间、术后月经恢复时间、术后宫腔引流量比较差异均无统计学意义（P>0.05）；观察组患者手术时间显著长于对照组（P<0.05），住院时间、术后体温恢复正常时间均显著短于对照组（P<0.05）；观察组患者住院费用显著少于对照组（P<0.05）。对照组患者术后7例出现发热，5例出现不同程度的臀部疼痛,1例经血量较术前明显减少；观察组患者术后无明显不适。结论　腹腔镜下暂时性子宫动脉结扎术治疗Ⅲ型子宫瘢痕妊娠疗效显著，可缩短患者住院时间及术后体温恢复正常时间，且术后并发症少。
Abstract:
Objective　To investigate the efficacy of temporary uterine artery ligation under laparoscope in treatment of type Ⅲ cesarean scar pregnancy(CSP).Methods　A total of 40 patients with type Ⅲ CSP admitted to the Fourth Hospital of Hebei Medical University from January 2016 to May 2018 were selected as research subjects,and they were divided into the observation group（n=17） and the control group（n=23）according to operation mode.The patients in the control group received uterine arterial embolism(UAE) and laparoscopic resection and repair of scar pregnancy site,while the patients in the observation group received temporary uterine artery ligation under laparosope and resection and repair of scar pregnancy site.The intraoperative blood loss,operation time,hospitalization stay,hospitalization cost,postoperative temperature return to normal time(falling below 37.3 ℃),postoperative intrauterine drainage,serum β-human chorionic gonadotropin (β-HCG) decreased to normal stay and postoperative menstrual recovery time were compared between the two groups.Results　The patients in the both groups were successfully completed the operation.There was no statistically significant difference in intraoperative blood loss,postoperative β-HCG return to normal time,postoperative menstrual recovery time,and postoperative uterine drainage between the two groups (P>0.05);the operation time in the observation group was significantly longer than that in the control group (P<0.05),the hospitalization stay and the postoperative body temperature return to normal time in the observation group were significantly shorter than those in the control group (P<0.05),and the hospitalization cost in the observation group was significantly less than that in the control group (P<0.05).In the control group,there were 7 cases of fever after operation,5 cases of hip pain of varying degrees,and 1 case of menstrual flow decreased significantly；and there was no obvious discomfort in the observation group.Conclusion　Temporary uterine artery ligation under aparoscope has a significant therapeutic effeet on type Ⅲ CSP,which can shorten the hospitalization stay and the postoperative body temperature return to normal time,and with few postoperative complications.

参考文献/References:

［1］　HAN W,SONG J,LIU A,et al.Trends in live births in the past 20 years in Zhengzhou,China［J］.Acta Obstet Gynecol Scand,2011,90(4):332-337.
［2］　VIAL Y,PETIGNAT P,HOHLFELD P.Pregnancy in a cesareanscar［J］.Ultrasound Obstet Gynecol,2000,16(6):592-593.
［3］　中华医学会妇产科学分会计划生育学组.剖宫产瘢痕妊娠诊治专家共识（2016）［J］.全科医学临床与教育,2016,51(8):568-572.
［4］　张晓薇.剖宫产术后子宫瘢痕妊娠31例的早期诊断与处理［J］.海军医学杂志,2015,35(1):15.
［5］　曾红艳,戴常平,白洁.剖宫产瘢痕妊娠的超声及MRI特征［J］.中国医学影像学杂志,2015,23(8):622-625.
［6］　李康宁.超声在剖宫产瘢痕妊娠术前诊断、风险评估及远期随访中的临床应用研究［D］.北京:北京协和医学院,2016.
［7］　ROZENBERG P,GOFFINET F,PHILLIPPE H J,et al.Ultrasonographic measurement of lower uterine segment to assess risk of defects of scarred uterus［J］.Lancet,1996,347(8997):281-284.
［8］　ASH ASMITH A,MAXWELL D.Caesarean scar pregnancy［J］.BJOG,2007,114 (3):253-263.
［9］　HOLLAND M G,BIENSTOCK J L.Recurrent ectopic pregnancy in a cesarean scar［J］.Obstet Gynecol,2008,111(2 Pt 2):541-545.
［10］　WANG J H,QIAN Z D,ZHUANG Y L,et al.Risk factors for intraoperative hemorrhage at evacuation of a cesarean scar pregnancy following uterine artery embolization［J］.Int J Gynaecol Obstet,2013,123(3):240-243.
［11］　WANG G W,LIU X F,BI F F,et al.Evaluation of the efficacy of laparoscopic resection for the management of exogenous cesarean scar pregnancy［J］.Fertil Steril,2014,101(5):1501-1507.
［12］　陈敏.腹腔镜下切除剖宫产瘢痕妊娠病灶的临床分析［J］.中国内镜杂志,2016,22(6)：104-106.
［13］　石延辉.超声引导下精准介入治疗不同超声分型子宫瘢痕妊娠疗效观察［J］.新乡医学院学报,2018,35(8):722-726.
［14］　李玉梅.宫腔镜下清宫术治疗剖宫产术后瘢痕妊娠疗效观察［J］.新乡医学院学报,2014,31(9):735-736.
［15］　李艳川,邓小艳,樊阳阳,等.甲氨蝶呤灌注联合子宫动脉栓塞和超声引导下刮宫术治疗子宫瘢痕妊娠的疗效及安全性［J］.新乡医学院学报,2019,36(3):246-249.
［16］　OUYANG Z,YIN Q,XU Y,et al.Heterotopic cesarean scar pregnancy:diagnosis,treatment,and prognosis［J］.J Ultrasound Med,2014,33(9):1533-1537.
［17］　GODIN P A,BASSIL S,DONNEZ J.An ectopic pregnancy developing in a previous caesarian section scar［J］.Fertil Steril,1997,67(2):398-400.
［18］　PELAGE J P,LE DREF O,SOYER P,et al.Fibroid-related menorrhagia:treatment with superselective embolization of the uterine arteries and midterm follow-up［J］.Ｒadiology,2000,215(2):428-431．
［19］　WALKER W J,PELAGE J P.Uterine artery embolisation for symptomatic fibroids:clinical results in 400 women with imaging follow up［J］.BJOG,2002,109(11):1262-1272.
［20］　林啸笑,孙待飞,傅君,等.子宫动脉栓塞术治疗产后出血对再次妊娠结局的影响［J］.浙江大学学报（医学版）,2019,48(5):540-545．
［21］　罗芳,朱元全,李寅,等.70例子宫动脉栓塞术并发症分析［J］.昆明医科大学学报,2020,41(4):97-102.
［22］　张美云,赵映魁.子宫动脉栓塞副反应及并发症研究进展［J］.河北医药,2008,30(2):212- 214.
［23］　郭文波,杨建勇,陈伟,等.子宫动脉栓塞术前后性激素水平的变化［J］.介入放射学杂志，2002,11(3):189- 190.

相似文献/References:

[1]陈赜,陈杰,严想元,等.腹腔镜辅助胃癌根治术治疗早期胃癌疗效观察[J].新乡医学院学报,,():000.
[2]邹心忠.腹腔镜下卵巢良性肿瘤剥除术27例分析[J].新乡医学院学报,2001,18(03):212.
[3]周振华,苏国强,张保峰.开腹胆囊切除术和腹腔镜胆囊切除术并发症的比较[J].新乡医学院学报,2002,19(04):301.
[4]程章林,党铁成.急性炎症期腹腔镜胆囊切除术43例分析 [J].新乡医学院学报,2006,23(01):000.
[5]朱翠兰.腹腔镜下保守手术治疗输卵管妊娠32例 [J].新乡医学院学报,2007,24(03):259.
[6]林凛然,方碧梅.腹腔镜下手术治疗异位妊娠疗效观察[J].新乡医学院学报,2008,25(01):060.
[7]陶桂娥,苏卫华.腹腔镜治疗休克型异位妊娠53例 TitleFilter('chTitle');[J].新乡医学院学报,2010,27(04):401.
[8]刘承利,徐新保,张洪义,等.腹腔镜联合纤维胆道镜胆总管探查取石术22 例[J].新乡医学院学报,2011,28(06):000.
[9]程新豹.腹腔镜联合胆道镜在胆囊结石合并胆总管结石中的应用[J].新乡医学院学报,2012,29(08):606.
[10]刘琛姝,王永莉,潘玉韵.腹腔镜手术和开腹手术在早期卵巢肿瘤分期探查术中的应用效果及术后并发症比较 [J].新乡医学院学报,2012,29(10):795.

更新日期/Last Update: 2020-09-05