双侧子宫动脉栓塞联合宫腔镜清宫术治疗剖宫产瘢痕妊娠的效果分析

Clinical analysis of bilateral uterine artery embolization combined with hysteroscopic curettage in the treatment of cesarean scar pregnancy

目的分析子宫动脉栓塞（uterine artery embolization,UAE）联合宫腔镜手术治疗剖宫产瘢痕妊娠（cesarean scar pregnancy,CSP）的效果。方法选择漯河医学高等专科学校第二附属医院2010年3月至2013年6月收治的48例CSP患者,采用双侧子宫动脉栓塞（bilateral uterine artery embolism,BUAE）联合宫腔镜清宫术治疗。观察患者术中出血量、手术时间、术后β-人绒毛膜促性腺激素（human chorionic gonadotropin,HCG）的水平、住院时间、术后不良反应发生率、治愈率,记录随访患者术后月经、超声及再次受孕情况。结果 48例确诊患者均在UAE术后24-72 h内进行宫腔镜指导下清宫术,47例患者治愈,术中出血量（20-150）m L,平均（40.2±36.7）m L,手术时间为20-40 min,血β-HCG于术后15-30 d降至正常,月经周期于术后30-45 d恢复正常,住院时间5-10 d,平均7.2 d,治愈率97.9%。术后病理为出血坏死组织中查见绒毛组织。仅有1例患者在栓塞治疗清宫术后持续少量出血50 d,行手术切除部分瘢痕后痊愈。结论双侧子宫动脉栓塞联合宫腔镜清宫术治疗CSP的效果良好。

Objective To analyze the effect of bilateral uterine artery embolism （UAE） combined with hysteroscopic curettage in the treatment of cesarean scar pregnancy （CSP）. Methods A total of 48 cases with CSP in The Second Affiiated Hospital of Luohe Medical College from March 2010 to June 2013 were chosen, all cases were treated by UAE combined with hysteroscopic curettage. The indexes such as intraoperative blood loss, operative time, postoperative human chorionic gonadotropin （ β - HCG） levels, length of hospital stay, postoperative incidence of adverse reactions, the cure rate of observation were observed, the follow - up situations such as postoperative period, ultrasound and pregnant again were recorded. Results 48 cases underwent hysteroscopic curettage within 24 -72 hours after UAE. 47 cases were cured, the mean intraoperative blood loss was 20 - 150 mL with an average of （40.2 ±36.7） mL. The mean operative time was 20 - 40 minutes. The mean time of β - HCG resolution was 15 - 30 days. The mean time of returning to normal menstrual cycle was 30 - 45 days after surgery. The hospital stays were 5 - 10 days with an average of 7.2 days. The cure rate was 97.9 %. Postoperative pathological diagnosis showed the chorionie villi in hemorrhagic and necrotic tissue. Only 1 ease appeared eontinuous postoperative bleeding for 50 days after UAE who were cured by operation resection of partial sear. Conclusion The UAE combined with hysteroscopic curettage has a good effect in the treatment of CSP.