摘要
目的 探究双侧髂内动脉Fogarty球囊阻断术在剖宫产术后瘢痕妊娠(CSP)辅助清宫手术中的临床疗效与安全性.方法 回顾性分析阜阳市人民医院 2021 年 1 月至 2022 年 9 月收治的 80 例CSP患者临床资料.其中观察组 40 例,给予双侧髂内动脉Fogarty球囊阻断术下行宫腔镜下清宫治疗,术中间断阻断髂内动脉,清除胚胎、电凝或缝合止血;对照组 40 例,给予子宫动脉栓塞术(UAE)后 1～2 d行宫腔镜下清宫手术.对比分析两组患者在数字减影血管造影(DSA)下透视时间、体表辐射剂量、清宫手术中出血量、清宫手术时间、住院时间及术后随访情况.结果 所有患者清宫手术顺利,成功保留子宫.观察组未发生球囊相关的并发症.对照组 40 例患者UAE后均发生不同程度发热、子宫区疼痛等栓塞后反应.观察组、对照组DSA 下透视时间及体表辐射剂量分别为(9.2±1.1)s vs(1 273.6±141.1)s、(7.7±0.8)mGy vs(1503.8±101.8)mGy,分别比较,差异均有统计学意义(均P＜0.05);清宫时术中出血量分别为(30.3±14.7)mL、(27.5±13.2)mL,清宫手术时间分别为(41.6±16.2)min、(42.8±15.0)min,分别比较,差异均无统计学意义(均P＞0.05);住院时间分别为(6.0±0.7)d、(7.3±0.8)d,两组比较,差异有统计学意义(P＜0.05).随访期均在 3 个月以上,观察组、对照组人绒毛膜促性腺激素(β-hCG)转阴时间、阴道流血时间、月经恢复正常时间及患者满意率分别为(21.1±2.4)d vs(24.6±3.3)d、(8.2±1.1)d vs(13.6±2.6)d、(29.5±2.2)d vs(46.7±7.3)d、95.0%(38/40)vs 67.5%(27/40),分别比较,差异均有统计学意义(均P＜0.05).结论 双侧髂内动脉Fogarty球囊阻断术及UAE 辅助CSP 清宫手术均可明显减少术中出血量,但双侧髂内动脉Fogarty球囊阻断术相比于UAE,减少患者X线辐射剂量,缩短患者住院、β-hCG转阴、阴道流血、月经恢复正常时间,增加患者满意度率.
Abstract
Objective To discuss the clinical efficacy and safety of bilateral internal iliac artery Fogarty balloon occlusion in uterine curettage for patients with cesarean scar pregnancy(CSP).Methods The clinical data of a total of 80 CSP patients,who were admitted to the Fuyang People's Hospital of China between January 2021 and September 2022 to receive treatment,were retrospectively analyzed.The patients were divided into the observation group(n=40)and the control group(n=40).For the patients of the observation group,the hysteroscopic uterine curettage was carried out under the situation of bilateral internal iliac artery Fogarty balloon occlusion and during the operation the internal iliac artery was intermittently blocked.The embryo was removed,and the hemostasis was accomplished by electrocoagulation or surgical suture.For the patients of the control group,the hysteroscopic uterine curettage was performed within 1-2 days after uterine artery embolization(UAE).The digital subtraction angiography(DSA)fluoroscopy time,body surface radiation dose,blood loss during uterine curettage,time spent for uterine curettage,length of hospital stay,and postoperative follow-up results were compared between the two groups.Results Successful uterine curettage was accomplished and the uterus was retained in all the patients.In the observation group,no balloon-related complications occurred.In the control group,all the 40 patients developed different degrees of fever,pain at uterine area,and other post-embolization symptoms after UAE.In the observation group and the control group,the DSA fluoroscopy time was(9.2±1.1)seconds and(1 273.6±141.1)seconds respectively,the body surface radiation dose was(7.7±0.8)mGy and(1 503.8±101.8)mGy respectively,the differences between the two groups were statistically significant(both P＜0.05);the blood loss during uterine curettage was(30.3±14.7)mL and(27.5±13.2)mL respectively,the time spent for uterine curettage was(41.6±16.2)min and(42.8±15.0)min respectively,the differences between the two groups were not statistically significant(both P＞0.05);the length of hospital stay was(6.0±0.7)days and(7.3±0.8)days respectively,the difference between the two groups was statistically significant(P＜0.05).All patients were followed up for more than 3 months,the time of β-hCG turning to negative,time of vaginal bleeding,time of menstruation returning to normal,and patient satisfaction rate in the observation group were(21.1±2.4)days,(8.2±1.1)days,(29.5±2.2)days and 95.0%(38/40)respectively,which in the control group were(24.6±3.3)days,(13.6±2.6)days,(46.7±7.3)days and 67.5%(27/40)respectively,the differences in the above indexes between the two groups were statistically significant(all P＜0.05).Conclusion In performing uterine curettage for CSP patients,both bilateral internal iliac artery Fogarty balloon occlusion and UAE can significantly reduce the intraoperative blood loss,but bilateral internal iliac artery Fogarty balloon occlusion is superior to UAE in reducing radiation dose,in shortening the patient's hospital stay,the time of β-hCG turning to negative,the time of vaginal bleeding and the time of menstruation returning to normal,and in improving the patient satisfaction rate.
基金项目
中国红十字基金会医学赋能-领航精英科研项目(XM-HR-YXFN-2021-05-24)
中国红十字基金会医学赋能公益专项基金2023年镇痛行动临床科研项目(CRCF-YXFN-202302105)
NETL
NSTL
万方数据