子宫动脉栓塞术治疗剖宫产瘢痕部位妊娠相关问题探讨

Correlation Questions Clinical Discussion of Uterine Artery Embolization in Induced Abortion Patients with Management of Pregnancy in A Cesarean Scar Pregnancy

目的:探讨子宫动脉栓塞术(UAE)辅助治疗剖宫产术后子宫瘢痕部位妊娠(CSP)的临床效果及相关问题处理对策。方法:51例CSP病例,扩刮宫术(D&C)前采用明胶海绵进行UAE,术后观察终止妊娠术中出血量、术后并发症、血hCG下降情况、超声检测子宫异常妊娠局部情况及费用等。结果:38例UAE后行扩刮宫术(A组),10例行UAE+D&C术前已应用药物治疗(天花粉3例,氨甲喋呤7例)(B组)。3例患者直接扩刮宫术时因大出血行子宫腔填塞术,同时施行紧急UAE(C组)。血β-hCG恢复正常值时间、术中出血量A、B组间均无差异;A组住院时间和治疗总费用远低于B组,P<0.01。结论:终止剖宫产瘢痕部位妊娠术前采用UAE辅助治疗,具有疗效确切、安全、住院时间短等特点,有条件的医院可选择先行UAE再刮宫治疗方案。

Objective： To analyze the utility of uterine aterial embolization （UAE） in terminating cesarean scar pregnancy （CSP） retrospectively. Methods： Fifty-five women with CSP cesarean scar pregnancy were pretreated with UAE before dilatation ＆ curettage （D＆C）. Indexes such as bleeding volume amount, operation-associated complications, serum hCG level, ultrasound imaging and hospitalization cost were analyzed. Results： Thirty-eight women had D＆D curettage following UAE （group A）, 10 had medicine （3 cases, trichosanthin; 7 cases, MTX） injection before UAE and D＆C curettage （group B）. Uterine packing and then emergency UAE were performed in another 3 women due to severe bleeding during direct curettage without pretreatment （group C）. There were no differences of the time of serum [3-hCG level dropped to normal and the average bleeding ovlume during the operation between group A and B. The average duration of hospital stay and the average cost of hospitalization in group A were less than those in group B, P〈0.01. Conclusion： Pretreatment with UAE before curettage is safe and effective for terminating CSP termination, and it can also reduce hospitalization cost. UAE followed by curettage is suggested supposed to be recommended in the hospitals with UEA equipment and conditions well-equipped health facilities.