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超声引导下行刮宫术治疗剖宫产术后瘢痕妊娠的意义和临床应用价值
作者:刘洋洋1  刘会玲1  王志欣2  史华宁1  秦诗阳1  丁华杰1 
单位:1. 承德医学院附属医院 超声科, 河北 承德 067000;
2. 承德市第三医院 放射科, 河北 承德 067000
关键词:术后子宫瘢痕妊娠 刮宫术 超声引导 
分类号:R445.1;R713.41
出版年·卷·期(页码):2017·36·第四期(533-537)
摘要:

目的:探索剖宫产后子宫愈合情况和刮宫术出血量对瘢痕妊娠的影响,评估瘢痕形态是否适宜再妊娠。方法:选取2010年10月至2014年10月经承德医学院附属医院诊断的术后子宫瘢痕妊娠(CSP)患者61例,在超声引导下行刮宫术治疗,治疗后半年进行复查。根据患者刮宫术后2年内怀孕成功情况分为成功组(A组)与失败组(B组),对比分析两组患者刮宫术中出血量、尿β人绒毛膜促性腺激素(β-HCG)恢复阴性时间、复查时瘢痕处肌层增厚与否、血流是否异常以及卵泡刺激素(FSH)水平和黄体生成素(LH)水平是否异常。结果:刮宫术时出血量对CSP患者术后2年内怀孕具有一定的影响(P<0.05),尿β-HCG恢复时间对CSP患者再妊娠成功与否影响不大(P>0.05)。瘢痕肌层增厚及瘢痕处血流异常对CSP刮宫术后2年内怀孕影响较大(P<0.05),FSH水平和LH水平异常对CSP刮宫术后2年内怀孕影响不大(P>0.05)。结论:剖宫产时出血量大、瘢痕肌层增厚及瘢痕处血流异常对CSP患者再妊娠具有重要的影响,此类情况再妊娠时须密切关注妊娠情况。

Objective:To explore the effects of curettage bleeding and healing of the uterus after cesarean on cesarean scar pregnancy(CSP), and assess the suitability for pregnancy. Methods:61 CSP cases from October 2010 to October 2014 underwent ultrasound-guided curettag. They were followed up for 6 months and then were divided into effective group (group A) and failure group (group B) within 2years after the curettage. An comparison and analysis of two sets of curettage bleeding, time for urinary β-HCG resumption to negative and review of scar thickening, blood flow FSH and LH levels. Results:Curettage bleeding on the postoperative patients with CSP had some impact on pregnancy within 2 years (P<0.05), and urinary β-HCG recovery time impact had no impact on pregnancy within 2 years (P>0.05). The scar muscle thickening and abnormal blood flow to CSP curettage pregnancy within 2 years after the success had great influence (P<0.05). Abnormal levels of FSH and LH with CSP curettage pregnancy within 2 years after had little influence on success of pregnancy (P>0.05). Conclusion:Bleeding, scarring and the cesarean section muscle thickening in patients with abnormal blood flow has a significant impact on CSP pregnancy. Close attention should be paid to bleeding, thickening of muscle scar and abnormal blood flow during cesarean.

参考文献:

[1] 廖彩华,陈禄英,林丽.子宫疤痕妊娠的经腹及经阴道彩色多普勒超声诊断价值分析[J].中国临床医学影像杂志,2016,27(1):42-44.
[2] 殷丽丽,杨清.剖宫产瘢痕妊娠研究进展[J].中国实用妇科与产科杂志,2015,31(4):361-365.
[3] 梁致怡,苏继颖,杨华.剖宫产术后子宫瘢痕妊娠清宫治疗的可行性分析[J].中华医学杂志,2015,95(37):3045-3049.
[4] ZHU X,DENG X,WAN Y,et al.High-intensity focused ultrasound combined with suction curettage for the treatment of cesarean scar pregnancy[J].Medicine,2015,94(18):e854.
[5] 孙懿,聂小毳.经阴道彩色多普勒超声诊断剖宫产切口瘢痕妊娠的临床价值[J].中国实用妇科与产科杂志,2015,31(2):149-152.
[6] 梁海霞,陈必良,李玉虹,等.剖宫产瘢痕妊娠两种治疗方法分析[J].现代医学,2016,44(3):299-302.
[7] 廖莎,施倩,马青琳,等.阴道超声对剖宫产疤痕早期妊娠治疗的临床意义[J].中国临床医学影像杂志,2016,27(3):218-219.
[8] HUANG Q,ZHANG M,ZHAI R Y.Comparison of gadolinium-enhanced magnetic resonance imaging with ultrasound in evaluation of cesarean scar pregnancy[J].J Obstet Gynaecol Res,2014,40(7):1890-1893.
[9] 李阳,岑秀雅,高源统,等.剖宫产术后子宫瘢痕妊娠诊断:阴道彩超与MRI比较[J].中国医学计算机成像杂志,2015,21(1):53-56.
[10] 李康宁,戴晴,刘真真,等.超声在剖宫产瘢痕妊娠大出血风险评估中的应用价值[J].中国医学科学院学报,2015,37(5):585-590.
[11] XIAO J,ZHANG S,WANG F,et al.Cesarean scar pregnancy:noninvasive and effective treatment with high-intensity focused ultrasound[J].Am J Obstet Gynecol,2014,211(4):1-7.
[12] 胡乔飞,李长东,陈素文,等.不同手术方式治疗剖宫产瘢痕妊娠术后人绒毛膜促性腺激素的变化趋势[J].中华医学杂志,2016,96(29):2332-2335.
[13] 欧阳振波,尹倩,全松,等.复发性剖宫产瘢痕妊娠的诊断及治疗[J].现代妇产科进展,2016,25(10):754-756,761.
[14] HUANG L,DU Y,ZHAO C.High-intensity focused ultrasound combined with dilatation and curettage for Cesarean scar pregnancy[J].Ultrasound Obstet Gynecol,2014,43(1):98-101.
[15] 谢秋娴,谢昭雄,陈婵玉,等.腹腔镜下不同术式应用于不同临床分型的剖宫产瘢痕妊娠的疗效分析[J].重庆医学,2016,45(8):1072-1074.
[16] 王泽鑫,李建明,贾广志.子宫动脉化疗栓塞术联合刮宫术治疗剖宫产瘢痕妊娠的临床疗效[J].中国介入影像与治疗学,2014,11(1):15-18.

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