Chen Z Y, Li X Y, Zhao D, Zhou M, Xu P, Huang X F, Zhang X M
Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China.
Zhonghua Fu Chan Ke Za Zhi. 2017 Oct 25;52(10):669-674. doi: 10.3760/cma.j.issn.0529-567X.2017.10.005.
To investigate the safety and efficacy of hysterosopic management of type Ⅱ cesarean scar pregnancy (CSP) and the value of prophylactic uterine artery embolization (UAE). Totally 104 patients with type Ⅱ CSP treated with hysteroscopic surgery at the Womens Hospital, School of Medicine, Zhejiang University, during Jan. 2009 to Jun. 2016 were analyzed retrospectively, 67 patients combined with UAE (UAE group) and 37 patients without combined with UAE (non-UAE group). Laparoscopy or sonography guidance was conducted simultaneously. The following clinical parameters were compared, including: primary cure rate, uterine packing rate, uterine perforation rate, hemoglobin level change, the time for the mass absorption and the return of β-hCG to normal, complications, hospital days and hospital stay cost. Median gestational age, size of mass, thickness of the anterior myometrium and β-hCG level in UAE group versus non-UAE group were 47 versus 47 days, 30 versus 30 mm,2 versus 2 mm, 36 524 versus 32 226 U/L (all 0.05). Out of 104, 100 patients were managed successfully with hysteroscopic surgery, and 4 patients transformed to laparoscopic or laparotomy surgery. Hysteroscopic surgery was effective in 63 out of 67 patients (94%) in UAE group and 34 out of 37 patients (92%) in non-UAE group (0.05). There was no significant differences regarding uterine perforation rate, uterine packing rate, hemoglobin change and recovery time between UAE group and non-UAE group (all 0.05). The median hospital day was 7 days in UAE group versus 5 days in non-UAE group (0.01). The median hospital stay cost was 13 654 yuan in UAE group versus 9 108 yuan in non-UAE group (0.01). Serious complication occurred in 4 patients (6%, 4/67) in UAE group and 2 patients (5%, 2/67) in non-UAE group (0.906). Hysteroscopic surgery is effective and safe for patients with type Ⅱ CSP in the first trimester with size ≤30 mm in diameter and gestation age<7 weeks. The value of prophylactic UAE is uncertain.
探讨宫腔镜治疗Ⅱ型剖宫产瘢痕妊娠（CSP）的安全性、有效性及预防性子宫动脉栓塞术（UAE）的价值。回顾性分析2009年1月至2016年6月在浙江大学医学院附属妇产科医院接受宫腔镜手术治疗的104例Ⅱ型CSP患者，其中67例联合UAE治疗（UAE组），37例未联合UAE治疗（非UAE组）。同时进行腹腔镜或超声引导。比较以下临床参数：初次治愈率、子宫填塞率、子宫穿孔率、血红蛋白水平变化、包块吸收时间及β-hCG恢复正常时间、并发症、住院天数及住院费用。UAE组与非UAE组的中位孕周、包块大小、前壁肌层厚度及β-hCG水平分别为47天对47天、30mm对30mm、2mm对2mm、36524U/L对32226U/L（均P>0.05）。104例患者中，100例成功接受宫腔镜手术，4例转为腹腔镜或开腹手术。UAE组67例患者中63例（94%）宫腔镜手术有效，非UAE组37例患者中34例（92%）有效（P>0.05）。UAE组与非UAE组在子宫穿孔率、子宫填塞率、血红蛋白变化及恢复时间方面差异均无统计学意义（均P>0.05）。UAE组中位住院天数为7天，非UAE组为5天（P=0.01）。UAE组中位住院费用为13654元，非UAE组为9108元（P=0.01）。UAE组4例患者（6%，4/67）发生严重并发症，非UAE组2例患者（5%，2/67）发生严重并发症（P=0.906）。宫腔镜手术治疗孕早期直径≤30mm、孕周<7周的Ⅱ型CSP患者有效且安全。预防性UAE的价值尚不确定。
