子宫动脉栓塞术后清宫与腹腔镜下病灶切除术在子宫瘢痕妊娠治疗中的应用

Clinical effect of curettage after bilateral uterine artery embolization and laparoscopic resection for treatment of cesarean scar pregnancy

目的探讨双侧子宫动脉栓塞术(uterine arterial embolization,UAE)后清宫及腹腔镜下病灶切除术在治疗剖宫产切口瘢痕妊娠中的临床效果。方法分析46例剖宫产切口瘢痕妊娠患者,行UAE后B超引导下行清宫术的24例为UAE组,行腹腔镜下病灶切除治疗的22例为腹腔镜组。分析2组临床一般资料,手术中出血量、手术时间、住院时间和术中并发症的发生率,术后人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)下降情况,月经复潮情况。结果 2组年龄、孕次、术前HCG值、病灶大小、距前次剖宫产时间差异均无统计学意义(P>0.05)。UAE组有1例因清宫过程中出现大出血转开腹手术外,余23例均顺利完成手术。腹腔镜组术中出血量、手术时间以及住院时间均少于UAE组(P<0.05)。腹腔镜组HCG降至正常时间、月经复潮时间均短于UAE组(P<0.05)。结论剖宫产切口瘢痕妊娠行UAE后清宫治疗及腹腔镜下病灶切除均安全可行,与UAE组相比,腹腔镜手术在手术过程及患者恢复方面具有一定优势,更值得临床开展。

Objective To investigate the clinical effect of bilateral uterine artery embolization （UAE） and laparoscopic resection for the treatment of cesarean scar pregnancy.Methods Forty- six patients with cesarean scar pregnancy were analyzed, 24 patients underwent UAE, then performed an uterine curettage guided by ultrasound called UAE group, 22 cases used laparoscopic lesion resection called laparoscopic group.Clinical general information were analyzed, including intraoperative blood loss, operative time, length of hospital stay, complication of operation, HCG drops and menstrual regain after operation. Results Two groups showed no statistical significance in age, pregnant times, preoperative HCG value, focal size and the time from the previous cesarean delivery（P〉0.05）. One case from UAE group was transferred to laparotomy because the hemorrhage appeared in the process of uterine curettage, the other 23 cases successfully completed surgery. The intraoperative bleeding, operation time, length of hospital stay of laparoscopic group were better than those of UAE group（P〈0.05）.The time of HCG dropping to normal and the menstrual double tide time of the laparoscopic group were allshorter than those of UAE group （P〈 0.05）. Conclusion Laparoscopic resection can remove lesions, restore the original cesarean section incision scar,it is more worthy of widely use than UAE treatment in the cesarean delivery line incision scar pregnancy.