剖宫产术后切口妊娠运用子宫动脉栓塞术联合宫腔镜治疗的临床观察

Clinical observation of uterine artery embolization combined with hysteroscopy for treating cesarean scar pregnancy after C-section

目的研究剖宫产术后切口妊娠(CSP)运用子宫动脉栓塞术(UAE)联合宫腔镜治疗的临床观察。方法选取该院2011年7月至2013年7月收治的CSP患者76例,随机分成观察组(38例)和对照组(38例)。对照组实施肌肉注射氨甲蝶呤(MTX),在B超检测情况下实施清宫术。观察组实施UAE,并在宫腔镜下进行清宫术。观察并记录两组患者术中出血量、阴道流血时间、血β-人绒毛膜促性腺激素(HCG)转阴时间。对两组治疗后不良反应情况进行对比,包含腹痛、发热、丙氨酸氨基转移酶(ALT)异常以及白细胞下降。结果观察组患者术中出血量、阴道流血时间及血β-HCG转阴时间均明显低于对照组。治疗后观察组患者腹痛及发热发生率和对照组比较,差异均无统计学意义(P>0.05)。观察组ALT异常及白细胞下降发生率均明显低于对照组,差异均有统计学意义(P<0.05)。结论 CSP运用UAE联合宫腔镜治疗,创伤小、出血少,更加安全,术后恢复更快,术后不良反应少,值得临床推广应用。

Objective To observe the clinical effect of uterine artery embolization（UAE）combined with hysteroscopy for treating cesarean scar pregnancy（CSP）after C-section.Methods 76 cases of CSP treated in our hospital from July 2011 to July 2013 were selected and randomly divided into the observation group（38cases）and the control group（38cases）.The control group received intramuscular injection of methotrexate（MTX）,the complete curettage of uterine cavity was implemented under the B-ultrasound.The observation group was treated with UAE and curettage under hysteroscopy.The intraoperative bleeding volume,vaginal bleeding time,negative conversion time of bloodβ-HCG level were observed and recorded.The adverse reactions after treatment were compared between the two groups,including abdominal pain,fever,abnormal aminotransferase（ALT）and WBC decline were compared between the two groups.Results The intraoperative bleeding volume,vaginal bleeding time and negative conversion time of serumβ-HCG in the observation group were significantly lower than those in the control group.The occurrence rates of abdominal pain and fever after treatment in the observation group had no statistically significant difference compared with the control group（P〉0.05）.The occurrence rates of ALT abnormality and WBC decline in the observation group were significantly lower than those in the control group,the differences were statistically significant（P〈0.05）.Conclusion Adopting UAE combined with hysteroscopy for treating CSP has small trauma,less bleeding,more safety,faster postoperative recovery and less postoperative adverse reactions,and deserves to be clinically promoted and applied.