子宫动脉栓塞联合化疗在保守性治疗剖宫产瘢痕妊娠的疗效分析

Efficacy of uterine artery embolization combined with methotrexate for conservative treatment of cesarean scar pregnancy

目的：对比分析子宫动脉栓塞（UAE）联合化疗和单纯化疗在保守性治疗剖宫产瘢痕妊娠（CSP）的效果及相关影响因素。方法：选取2003年1月～2014年12月在中山大学附属第一医院确诊CSP且拒绝手术治疗的60例患者,其中22例行单纯MTX化疗,38例行UAE联合化疗。结果：单纯MTX化疗组中6例（27.3%）失败,化疗失败者的治疗前血β-HCG平高于化疗成功者（P=0.001）。UAE联合化疗组中2例（5.3%）治疗失败,住院时间、β-HCG转阴、正常月经恢复时间均较单纯MTX化疗组显著缩短（P〈0.001）,术后血β-HCG转阴及正常月经恢复与治疗前血β-HCG、孕周、妊娠囊大小等因素无相关性。结论：UAE联合化疗较单纯MTX化疗更有效,术后康复较快,且不受患者个体因素的影响。而治疗前高β-HCG是导致单纯MTX化疗失败的相关因素。

Objective： To analyze the efficacy and influencing factors of uterine artery embolization（ UAE） combined with methotrexate and systemic methotrexate for conservative treatment of cesarean scar pregnancy（ CSP）. Methods： 60 CSP patients who refused surgical therapy were included from Jan. 2003 to Dec. 2014 in the First Affiliated Hospital,Sun Yat-sen University. Among them,22 and 38 cases were treated with systematic methotrexate and UAE combined with methotrexate respectively. Results： In systematic methotrexate cases,6 cases（ 27. 3%） suffered from failed treatment and their level of serum β-HCG before treatment was higher than those who had successfulchemotherapy（ P = 0. 001）. Of patients receiving UAE combined with methotrexate,2 cases（ 5. 3%） were not successfully treated and the postoperative hospital stay,serum β-HCG and menstruation recovery were significantly shorter than those treated with systematic methotrexate（ P〈0. 001）. Furthermore,there were no significant correlations between postoperative serum β-HCG recovery,menstruation recovery and individual related factors including maximum diameter of gestational sac,gestational age and serum β-HCG level before treatment. Conclusion： Compared with systemic methotrexate,UAE combined with methotrexate is more effective and with a rapider recovery which is free from individual related factors. Moreover,the high level of serum β-HCG before treatment is a related factor of failed therapy of systemic methotrexate.