童小倩 刘仙

*基金项目：鹰潭市科技计划项目（Ykz2022080）

【摘要】 目的：分析经阴道子宫下段瘢痕妊娠病灶清除术联合子宫壁修补术在剖宫产术后瘢痕子宫妊娠患者中的效果。方法：选取2021年11月—2022年12月鹰潭一八四医院收治的50例剖宫产术后瘢痕子宫妊娠患者，按照随机数字表法将其分成对照组（n=25）、观察组（n=25）。对照组给予子宫动脉栓塞术+甲氨蝶呤+清宫术治疗，观察组行经阴道子宫下段瘢痕妊娠病灶清除术+子宫壁修补术，术后随访3个月。对比两组围手术期指标、术后恢复情况、生活质量、并发症。结果：观察组术中出血量为（65.21±4.48）mL，少于对照组的（87.49±6.37）mL（P<0.05）；观察组住院时间为（6.96±1.54）d、月经复潮时间为（31.35±2.56）d、血β-人绒毛膜促性腺激素（β-hCG）恢复正常时间为（18.36±1.59）d，

均短于对照组的（8.37±1.89）、（42.58±4.39）、（25.44±2.57）d（P<0.05）；观察组并发症发生率为8.00%（2/25），低于对照组的32.00%（8/25），差异有统计学意义（P<0.05）。术前，两组世界卫生组织生存质量测定量表（WHOQOL-BREF）各维度评分比较，差异均无统计学意义（P>0.05）；术后，观察组WHOQOL-BREF各维度评分分别为（75.96±3.42）、（74.39±4.08）、（76.84±3.44）、（72.49±3.49）分，高于对照组的（69.84±2.98）、（68.44±3.57）、（70.38±2.96）、（66.84±2.96）分，差异均有统计学意义（P<0.05）。结论：经阴道子宫下段瘢痕妊娠病灶清除术+子宫壁修补术具有创伤小、手术时间短等优势，有助于剖宫产术后瘢痕子宫妊娠患者术后恢复，提升生活质量，且并发症较少。

【关键词】 剖宫产术后瘢痕子宫妊娠 经阴道子宫下段瘢痕妊娠病灶清除术 子宫壁修补术 生活质量 并发症

Clinical Effect of Transvaginal Eradication of Low-segment Uterine Scar Pregnancy Focus Combined with Repair of Uterine Wall in the Treatment of Cicatricial Uterine Pregnancy after Cesarean Section/TONG Xiaoqian， LIU Xian. //Medical Innovation of China， 2024， 21（14）： 0-036

[Abstract] Objective： To analyze the effect of transvaginal eradication of low-segment uterine scar pregnancy focus combined with repair of uterine wall in patients with cicatricial uterine pregnancy after cesarean section. Method： A total of 50 patients with cicatricial uterine pregnancy after cesarean section treated in Yingtan 184th Hospital from November 2021 to December 2022 were selected and divided into control group （n=25） and observation group （n=25） according to random number table method. The control group was treated with uterine artery embolization + Methotrexate + evacuation of uterus， and the observation group was treated with transvaginal eradication of low-segment uterine scar pregnancy focus + repair of uterine wall， and followed up for 3 months. Perioperative indexes， postoperative recovery， quality of life and complications were compared between the two groups. Result： The intraoperative bleeding volume in the observation group was （65.21±4.48） mL，

less than （87.49±6.37） mL in the control group （P<0.05）. In the observation group， the hospitalization time was （6.96±1.54） d， the menstruation resurgence time was （31.35±2.56） d， the blood β-human chorionic gonadotropin

（β-hCG） return to normal time was （18.36±1.59） d， were shorter than （8.37±1.89）， （42.58±4.39）， （25.44±2.57） d

of control group （P<0.05）. The incidence of complications in the observation group was 8.00% （2/25）， lower than 32.00% （8/25） in the control group， the difference was statistically significant （P<0.05）. Before surgery， there were no statistical significance in the scores of each dimension of world health organization quality of life scale （WHOQOL-BREF） between the two groups （P>0.05）. After surgery， the scores of each dimension of WHOQOL-BREF in the observation group were （75.96±3.42）， （74.39±4.08）， （76.84±3.44）， （72.49±3.49） scores， were higher than （69.84±2.98）， （68.44±3.57）， （70.38±2.96）， （66.84±2.96） scores in the control group， the differences were statistically significant （P<0.05）. Conclusion： Transvaginal eradication of low-segment uterine scar pregnancy focus + repair of uterine wall has the advantages of less trauma and short operation time， which is conducive to postoperative recovery of patients with cicatricial uterine pregnancy after cesarean section， improve the quality of life， and have fewer complications.

[Key words] Cicatricial uterine pregnancy after cesarean section Transvaginal eradication of low-segment uterine scar pregnancy focus Repair of uterine wall Quality of life Complications

First-author's address： Department of Obstetrics and Gynecology， Yingtan 184th Hospital， Yingtan 335000， China

doi：10.3969/j.issn.1674-4985.2024.14.008

剖宫产术后瘢痕子宫妊娠属于异位妊娠的一种，在临床具有较高的发生率[1-2]。由于受精卵于剖宫产瘢痕处着床，容易诱发阴道流血等症状，且伴随胚胎的持续生长与孕囊的不断深入，将会导致疾病的危险程度加剧[3-4]。另外，随着孕囊的生长，极易导致子宫瘢痕部位发生破裂，最终引起大出血等严重后果，对患者生命安全造成威胁，故需施以及时有效的治疗[5]。子宫动脉栓塞术+甲氨蝶呤+清宫术为既往临床治疗剖宫产术后瘢痕子宫妊娠患者的重要手段，但对于年轻、有生育要求的患者而言，较难接受。近年，随着医学手段不断进步，阴式手术逐渐运用在临床。……