Wei Wei, Huang Lingxiu, Tang Fei, Wang Yu, Wang Jianmin, Song Guanghui
Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University Hangzhou 310016, Zhejiang, China.
Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University Hangzhou 310016, Zhejiang, China.
Am J Transl Res. 2024 Nov 15;16(11):6770-6778. doi: 10.62347/UOBH1544. eCollection 2024.
To assess and compare the clinical efficacy of scar pregnancy debridement by a combination of reversible bilateral uterine and internal iliac artery blockade with hysterolaparoscopy, as a management strategy for cesarean scar pregnancy.
This retrospective study included patients diagnosed with cesarean scar pregnancy who underwent combined surgical intervention involving hysteroscopy and laparoscopy between May 2020 and February 2024. The study population was divided into two groups based on the type of arterial blockade used: a uterine artery blockade group and an internal iliac artery blockade group. Data were retrospectively collected from patient medical records, including baseline characteristics, surgery-related details, and postoperative outcome.
The initial data revealed no discernible differences between the two groups in terms of age, number of caesarean sections, menstrual period, menstrual flow (light/medium/heavy), presence of dysmenorrhea, days of menopause, maximum human chorionic gonadotropin (hCG) levels, gestational tissue size on ultrasound imaging, reproductive hormones levels (E2/FSH/LH/progesterone), or anti-Müllerian hormone (AMH) (all P > 0.05). There were no apparent associations between the two groups in terms of the occurrence of adverse pregnancy outcome or ultrasound findings. However, the uterine artery group demonstrated shorter operative time, less bleeding, fewer postoperative hospital days, and lower overall hospital costs compared to the internal iliac artery group. Furthermore, the uterine artery group exhibited greater improvements in hCG and progesterone levels, menstrual periods, menstrual flow and dysmenorrhea than the internal iliac artery group. Additionally, the quality-of-life scores and a cumulative pregnancy rate were both significantly higher than in the control group.
The uterine artery group exhibited superior efficacy in the removal of scar pregnancies compared to the internal iliac artery group, under reversible uterine artery blockade by uterolaparoscopy in conjunction with bilateral uterine artery ligation. This procedure should be considered the preferred surgical approach for the aforementioned indication.
评估并比较经腹腔镜双侧子宫动脉和髂内动脉可逆性阻断联合宫腔镜下瘢痕妊娠病灶清除术的临床疗效，以此作为剖宫产瘢痕妊娠的一种治疗策略。
这项回顾性研究纳入了2020年5月至2024年2月期间诊断为剖宫产瘢痕妊娠并接受宫腔镜和腹腔镜联合手术干预的患者。根据所采用的动脉阻断类型，将研究人群分为两组：子宫动脉阻断组和髂内动脉阻断组。从患者病历中回顾性收集数据，包括基线特征、手术相关细节和术后结果。
初始数据显示，两组在年龄、剖宫产次数、月经周期、月经量（少/中/多）、痛经情况、绝经天数、最大人绒毛膜促性腺激素（hCG）水平、超声成像下妊娠组织大小、生殖激素水平（雌二醇/卵泡刺激素/黄体生成素/孕酮）或抗苗勒管激素（AMH）方面均无明显差异（所有P>0.05）。两组在不良妊娠结局的发生或超声检查结果方面均无明显关联。然而，与髂内动脉组相比，子宫动脉组的手术时间更短、出血量更少、术后住院天数更少且总体住院费用更低。此外，子宫动脉组在hCG和孕酮水平、月经周期、月经量和痛经方面的改善程度均高于髂内动脉组。此外，生活质量评分和累积妊娠率均显著高于对照组。
在腹腔镜下双侧子宫动脉结扎联合子宫动脉可逆性阻断的情况下，子宫动脉组在清除瘢痕妊娠方面的疗效优于髂内动脉组。对于上述适应证，该手术应被视为首选的手术方法。
