米非司酮、米索前列醇预处理联合宫腔镜手术对于Ⅱ型剖宫产瘢痕妊娠的疗效分析

Analysis of the Effect of Mifepristone and Misoprostol Pretreatment Combined with Hysteroscopy on Type Ⅱ Cesarean Scar Pregnancy

关键词:  剖宫产瘢痕妊娠|宫腔镜下清宫术|米非司酮|米索前列醇

Key words:  cesarean scar pregnancy|hysteroscopic curettage|mifepristone|misoprostol

摘要:

目的 探讨给予米非司酮、米索前列醇术前预处理联合宫腔镜下妊娠物清除术在Ⅱ型剖宫产瘢痕妊娠（cesarean scar pregnancy，CSP）中的治疗效果。方法 回顾性分析2017年1月-2018年12月无锡市妇幼保健院收治的CSP患者临床资料。依据中华医学会妇产科学分会2016年制定的CSP分型标准，将其中初始治疗采用米非司酮、米索前列醇术前预处理联合宫腔镜下妊娠物清除术的Ⅰ、Ⅱ型CSP患者共118例分为2组：Ⅰ型（61例）、Ⅱ型（57例）。收集患者一般资料及手术治疗相关指标（包括手术时间、术中出血量、住院天数、中转进腹率、单次手术成功率、总治愈率），评价治疗效果，并比较2组患者治疗效果有无差异。结果 2组间一般资料、手术时间、出血量、住院天数相比差异无统计学意义。Ⅰ、Ⅱ型CSP中转进腹手术率分别为4.9%和5.3%，单次宫腔镜手术成功率分别为91.8%和89.5%，无二次手术及子宫切除病例，总治愈率均为100%，2组相比差异无统计学意义。Ⅱ型组术中放置球囊压迫止血例数较Ⅰ型组增加，2组间比较差异有统计学意义（P<0.05）。结论 米非司酮、米索前列醇术前预处理联合宫腔镜下妊娠物清除术可同样安全有效地应用于Ⅱ型CSP患者，但围手术期需做好应对瘢痕部位大出血中转进腹行妊娠病灶清除及子宫瘢痕修补术的准备。

Abstract:

OBJECTIVE To explore the therapeutic effect of pretreatment with mifepristone and misoprostol combined with hysteroscopic clearance of pregnant material in type II cesarean scar pregnancy(CSP). METHODS The clinical data of CSP patients from January 2017-December 2018 in Wuxi Maternal and Child Health Hospital were analyzed retrospectively. According to the CSP classification standard formulated by the branch of Obstetrics and Gynecology of Chinese Medical Association in 2016, 118 patients with CSP of type I and type II were divided into 2 groups:type I(61 cases) and type II(57 cases). To collect the general data of patients and the relevant indexes of surgical treatment(including operation time, intraoperative bleeding volume, hospitalization days, conversion rate, single operation success rate, total cure rate), evaluate the treatment effect, and compare the treatment effect of the two groups. RESULTS There was no significant difference between the two groups in general data, operation time, blood loss and hospitalization days. The conversion rate of type I and type II CSP to abdominal surgery was 4.9% and 5.3%, respectively. The success rate of single hysteroscopic surgery was 91.8% and 89.5%, respectively. There was no case of second operation or hysterectomy, and the total cure rate was 100%. There was no statistical difference between the two groups. Compared with type Ⅰ, the cases of intraoperative balloon compression hemostasis in type Ⅱ increased, there was a significant difference between the two groups(P<0.05). CONCLUSION Mifepristone and misoprostol combined with hysteroscopic clearance of pregnancy can be equally safe and effective in the treatment of type II CSP patients, but peri operative preparations should be made to deal with the massive hemorrhage in the scar site and transfer to the abdomen for the removal of pregnancy focus and the repair of uterine scar.