He Yifeng, Wu Xin, Zhu Qiujing, Wu Xuezhe, Feng Lingda, Wu Xia, Zhao Aimin, Di Wen
Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China.
BMC Womens Health. 2014 Sep 24;14:116. doi: 10.1186/1472-6874-14-116.
The number of cesarean scar pregnancy (CSP) has significantly increased in the recent decade. Although uterine artery embolization (UAE) has been adopted to minimize the blood loss during uterine curettage removing of CSP, massive bleeding and uterine rupture can still be frequently encountered. The aim of this study was to compare the efficacy and safety of a novel combined laparoscopy and hysteroscopy technique with the traditional curettage in removing the conceptus and repairing the incision defect following the UAE management of CSP.
The CSP patients (n = 58) diagnosed between March 1, 2005 and March 1, 2010 were enrolled in three medical centers in Shanghai, China. All of these patients have undergone intra-arterial methotrexate, UAE and one of the following treatments: combined laparoscopy and hysteroscopy (study group, n = 25) and uterine curettage (control group, n = 33). Their medical records and 2-year outcomes were reviewed. The CSP removal rate, amount of blood loss during the treatment, incision repair rate (note: the post-curettage healing process of the incision defect was seen as a form of natural incision repairing, i.e., the self-repair mode), hospital stay, β-hCG regression time and postoperative sequelae were compared between two groups.
The CSP removal rate in the study group (100%) was significantly higher than that (79%) in the control group (p = 0.024). The average blood loss was 78.0 mL in the study group, which was much less than the 258.5 mL (p = 0.004) in the control group. A satisfactory incision repair rate (96%) was achieved in the study group, while it was 25% (p < 0.001) in the control group. Moreover, the study group had significantly shorter hospital stays (p = 0.043) and β-hCG regression times (p = 0.033), lower rates of postoperative abdominal pain (p = 0.035) and menstruation abnormalities (p = 0.043).
Combined laparoscopy and hysteroscopy is much safer and more effective than uterine curettage as a supplementary measure to remove the conceptus and repair the cesarean incision following the UAE management of CSP.
近十年来，剖宫产瘢痕妊娠（CSP）的数量显著增加。尽管已采用子宫动脉栓塞术（UAE）以尽量减少刮宫清除CSP时的出血量，但仍经常会遇到大出血和子宫破裂的情况。本研究的目的是比较一种新型腹腔镜与宫腔镜联合技术与传统刮宫术在UAE治疗CSP后清除妊娠物及修复切口缺损方面的疗效和安全性。
2005年3月1日至2010年3月1日期间诊断为CSP的患者（n = 58）在中国上海的三个医疗中心入组。所有这些患者均接受了动脉内甲氨蝶呤、UAE及以下治疗之一：腹腔镜与宫腔镜联合治疗（研究组，n = 25）和刮宫术（对照组，n = 33）。对其病历和2年的随访结果进行回顾。比较两组的CSP清除率、治疗期间的出血量、切口修复率（注：刮宫术后切口缺损的愈合过程视为自然切口修复的一种形式，即自我修复模式）、住院时间、β-hCG回归时间和术后后遗症。
研究组的CSP清除率（100%）显著高于对照组（79%）（p = 0.024）。研究组的平均出血量为78.0 mL，远低于对照组的258.5 mL（p = 0.004）。研究组的切口修复率令人满意（96%），而对照组为25%（p < 0.001）。此外，研究组的住院时间（p = 0.043）和β-hCG回归时间（p = 0.033）显著缩短，术后腹痛发生率（p = 0.035）和月经异常发生率（p = 0.043）较低。
作为UAE治疗CSP后清除妊娠物及修复剖宫产切口的辅助措施，腹腔镜与宫腔镜联合治疗比刮宫术更安全、更有效。
