子宫瘢痕妊娠两种疗法的对照研究

Comparative study of two kinds of therapy for uterine scar pregnancy

目的比较子宫动脉化学栓塞联合B型超声(B超)下清宫术与药物联合B超下清宫术两种方法在治疗剖宫产后瘢痕妊娠中的安全性及有效性。方法回顾分析53例子宫瘢痕妊娠患者的病历资料,将南通大学附属医院采用介入治疗的28例子宫瘢痕妊娠患者设为A组,南通市第一人民医院采用非介入治疗的25例子宫瘢痕妊娠患者设为B组,就其病史、临床表现以及治疗经过、治疗结果进行比较分析。结果 A组患者子宫动脉化疗栓塞术后48 h内B超引导下行清宫术治疗,未出现大出血或其他严重并发症,清宫术后患者出血量较术前明显减少或者消失。B组患者药物使用后在B超引导下行清宫术,4例患者因术中或术后24 h内持续性大出血,2例急症行子宫动脉栓塞术,术后随访未再次发生大出血,1例直接行开腹病灶切除术子宫瘢痕修补术,1例直接行子宫切除术。比较A、B两组的清宫过程出血量、血β-HCG值降至正常的时间及住院时间,P<0.05,差异有统计学意义。结论经子宫动脉化疗栓塞联合B超下清宫治疗瘢痕妊娠方法安全、有效、创伤小、无明显并发症,能避免盲目刮宫引起的大出血,缩短住院时间,降低子宫切除率,是子宫瘢痕妊娠特别是合并大量出血或预防高危大出血的首选治疗方法。

Objective To compare the safety and efficiency of interventional uterine arterial chemoembolization combined with ultrasound- guided curettage of uterine cavity and non- interventional medication combined with ultrasound- guided curettage of uterine cavity in treating cesarean scar pregnancy.Methods The clinical data of 53 female patients with cesarean scar pregnancy were retrospectively analyzed.The patients included 28 patients who were treated with interventional uterine arterial chemoembolization combined with ultrasound- guided curettage at the Affiliated Hospital of Nantong University（group A）, and 25 patients who were treated with non- interventional medication combined with ultrasound-guided curettage at the Nantong Municipal First People＇s Hospital（group B）. The clinical history, manifestations, the course of treatment and the therapeutic outcome were analyzed and compared between the two groups. Results For the patients of group A, ultrasound-guided curettage was performed at 48 hours after interventional uterine arterial chemoembolization. No massive bleeding or other severe complications occurred. After curettage, the vaginal bleeding was greatly decreased or disappeared. For the patients of group B, non-interventional medication was followed by ultrasound-guided curettage. Intraoperative or within postoperative 48 hours massive bleeding occurred in 4 cases; emergency uterine artery embolization had to be carried out in 2 cases, and no recurrence of massive bleeding during follow-up period; one case underwent direct laparotomy to remove the lesion and to repair the uterine scar; hysterectomy was directly employed in the remaining one case.Significant differences in the blood loss during curettage procedure, the time of serum β-HCG level falling to normal range and the hospitalization days existed between the two groups（P 0.05）. Conclusion For the treatment of cesarean scar pregnancy, interventional uterine arterial chemoembolization combined with ultrasound- guided curettage is safe, effective, mini- invasive with no obvious complications. This technique can avoid massive bleeding due to blind curettage, shorten the hospitalization time and reduce the rate of hysterectomy; therefore, it is the treatment of first choice for cesarean scar pregnancy, especially when massive bleeding is associated or when high risk of bleeding is possibly present.