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

摘要

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.%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.