子宫动脉栓塞联合宫腔镜治疗剖宫产瘢痕妊娠41例临床分析

Uterine artery embolization combined with hysteroscopic management on cesarean scar pregnancy in 41 cases

目的评价子宫动脉栓塞(UAE)联合宫腔镜治疗剖宫产瘢痕妊娠(CSP)的手术效果及结局。方法回顾性分析2005年1月至2012年6月北京大学人民医院住院行UAE联合宫腔镜手术的41例CSP患者的临床资料。结果 41例患者UAE术后均成功实施了宫腔镜手术,平均手术时间(26.0±13.1)min(10～60min),平均手术出血量(24.0±4.2)ml(20～30ml),平均住院天数(5.2±1.6)d(3～8d)。宫腔镜下见胎囊为外突型4例(9.7%),外突型平均手术时间[(42.5±17.1)min]显著低于内生型[(22.8±9.0)min;P=0.001];外突型平均孕周[(8.7±3.0)周]显著低于内生型[(6.7±1.7)周;P=0.041];二者β-hCG值、瘢痕厚度及血流阻力指数(RI)比较,差异均无统计学意义(P>0.05)。术后轻度发热者占9.7%(4/41)、轻至中度下腹痛者占24.4%(10/41)。随访率95.1%(39/41),术后平均血β-hCG值恢复时间(2.6±2.2)周(1～8周);平均月经恢复正常时间(4.4±1.3)周(4～12周)。其中1例患者2次栓塞术后出现闭经,经人工周期治疗术后6个月月经恢复。术后妊娠2例,1例为正常宫内妊娠,因计划外行人工流产术;1例再次发生剖宫产瘢痕妊娠,再次UAE+宫腔镜手术治疗。结论子宫动脉栓塞联合宫腔镜治疗剖宫产瘢痕妊娠是一个可靠的治疗选择,在保留了患者生育功能的同时,具有成功率高、并发症少、住院时间及血β-hCG值恢复时间短的优点。

Objective The aim of this study is to evaluate the effect of uterine combined with hysteroscopic treatment on caesarean scar pregnancy （CSP）. Methods artery embolization （UAE） Data of 41 CSP patients underwent UAE and hysteroscopy in the Peking University People＇s Hospital from January 2005 to June 2012 was anyalyzed retrospectively. Results The average operation time was （26.0± 13.1） min （range 10～60 min）, the average hemorrhage was （24.0±4.2） ml （range 20～30 ml） and the average inpatient days was （5.2± 1.6） d （range 3～8 d）. Among them, one case had a second UAE after hysteroscopy because of serious hemorrhage. Four cases （9.7%） were extrinsic sac type under hysteroscopy. The operation time of extrinsic sac type was significantly less than that of intrinsic sac type [ （42.5± 17.1） min vs （22.8±9.0） min, P= 0. 001]. The gestation time of extrinsic sac type was obviously less than that of intrinsic sac type [ （8.7±3.0） weeks vs （6.7±1.7） weeks, P=0. 041]. No statistical differences were found between the group of extrinsic sac and intrinsic sac in terms of the hCG value, scar thickness and vessel resistance index （RI）. Postoperative complications include： 9.7% （4/41） mild fever, 24.4% （10/41） mild to moderate lower abdominal pain. 95. 1% patients （39/41） were under follow-up. The hCG value dropped to normal between 1 to 8 weeks [ （2.6..2.2） weeks]. The recovery period of normal menstruation was 4 to 12 weeks [ （4.4±1.3） weeks]. One case became amenorrhea after two UAEs. The menstruation recovered to normal after six months of artificial cycle therapy. Being no fertility requirement, all patients underwent contraception. Two of them had accident pregnant, one was normal interuterine pregnancy and received artificial abortion, the other was CSP again and underwent UAE and hysteroscopy again. Conclusion The combine of UAE andhysteroscopy treatment is a reliable option for CSP, it has the advantage of high successful rate, less complications, less inpatient days and less recovery time of hCG level.