【摘要】 目的探讨超声监测下吸宫术治疗剖宫产瘢痕部位妊娠(CSP)的有效性、安全性及其不同治疗结局的相关影响因素。方法回顾性分析2016年1月至2018年12月在河北医科大学第二医院住院的以超声监测下吸宫术作为初始治疗方案的207例CSP患者,停经时间在26～84d,中位停经时间47d;包括Ⅰ型85例,Ⅱ型117例,Ⅲ型5例。所有患者均在超声监测下行吸宫术,依据术后血清β-hCG及超声复查情况,必要时补充手术治疗,包括宫腔镜残留病灶电切术及剖宫产瘢痕病灶清除+修补术。通过单因素分析和logistic分析,确定CSP吸宫后需补充手术治疗的影响因素。结果所有患者吸宫过程均成功,通过1次吸宫术达到治愈者179例,占86.5%,其中Ⅰ、Ⅱ型CSP治愈率分别为96.5%(82/85)和82.9%(97/117)。补充手术者28例。7例术中出血量≥200mL,占3.4%,并无子宫穿孔、膀胱损伤或因大出血行子宫动脉栓塞术,甚至导致子宫切除等情况发生。单因素分析显示,CSP采用吸宫术治疗后是否需补充手术与患者的停经时间、术前血清β-hCG、孕囊大小、剩余肌层厚度、药物预处理、术毕填塞止血有关。logistic分析显示,CSP吸宫后需补充手术治疗的独立影响因素是孕囊大小(OR=4.652,P=0.004)、剩余肌层厚度(OR=5.154,P=0.041)和术毕填塞止血(OR=3.859,P=0.013)。结论超声监测下吸宫术简单、安全、有效,可作为停经≤47d尤其是Ⅰ、Ⅱ型CSP患者首选治疗方案;当孕囊直径>3cm、剩余肌层厚度≤3mm、术毕需填塞止血时,吸宫后需补充手术治疗。更多还原

【Abstract】 Objective To investigate the efficacy and safety of ultrasound-guided uterine aspiration in the treatment of cesarean scar pregnancy(CSP)and the related factors influencing therapeutic outcomes.Methods A retrospective investigation was performed in 207 patients with CSP,who were hospitalized in the Second Hospital of Hebei Medical University and were given ultrasound-guided uterine aspiration as initial strategy from January 2016 to December 2018.The menstrual arrest time was 26-84 d and the median was 47 d.Among the subjects,there were 85 cases,117 cases and 5 cases of type Ⅰ,Ⅱ,and Ⅲ CSP respectively.All patients were given ultrasound-guided uterine aspiration.According to the serum β-human chorionic gonadotropin(β-hCG)changes and ultrasound reexamination after uterine aspiration,additional operations were done if necessary,including hysteroscopic resection of residual lesions and removal of residual embryonic materials along with repair of the uterine scar.Using univariate analysis and Logistic analysis,we analyzed the influencing factors of supplementary operations after uterine aspiration.Results All the patients received uterine aspiration successfully.Among the 207 cases,179 cases were cured by single time of uterine aspiration,accounting for 86.5%.Specifically,the cure rates of typeⅠand typeⅡCSP were 96.5%(82/85)and 82.9%(97/117),respectively.There were 28 cases who received supplementary operations.Seven cases had a blood loss of ≥ 200 ml during uterine aspiration,accounting for 3.4%.There was no uterine perforation,bladder injury,or uterine artery embolization or even hysterectomy due to massive hemorrhage.Univariate analysis showed that whether the supplementary surgical procedure was needed after uterine aspiration was related to the menstrual arrest time,serum β-hCG before the aspiration,the diameter of the pregnancy sac,the thickness of the remaining myometrium,the drug pretreatment,and hemostasis with packs after aspiration.Multivariate Logistic analysis showed that independent influencing factors of the supplementary surgical treatment after aspiration included the diameter of the pregnancy sac(OR=4.652,P=0.004),the thickness of the remaining myometrium(OR=5.154,P=0.041)and hemostasis with packs after uterine aspiration(OR=3.859,P=0.013).Conclusion Ultrasoundguided uterine aspiration is relatively simple,safe and effective in the treatment of CSP,and could be used as first line therapy for the patients with menstrual arrest time ≤47 d,especially for the type Ⅰ and Ⅱ CSP cases.Supplementary operations should be performed after uterine aspiration if the diameter of the pregnancy sac is >3 cm,or thickness of the remaining myometrium is ≤3 mm,or hemostasis with packs is needed after aspiration.更多还原