子宫动脉栓塞术后清宫术治疗剖宫产术后子宫瘢痕妊娠疗效观察

Therapeutic effect of uterine artery embolization combined with curettage on treatment of caesarean scar pregnancy

目的探讨子宫动脉栓塞后清宫术在治疗剖宫产术后子宫瘢痕妊娠(CSP)的可行性。方法回顾性分析2008年12月至2014年9月在青岛大学附属医院妇科收治的97例符合CSP诊断标准的患者的临床资料。其中48例行子宫动脉栓塞后清宫术(栓塞组),49例行开腹病灶清除术(开腹组)。比较两组患者手术时间、术中出血量、手术后住院时间、术后血清β-hCG转为正常值的时间。结果两组手术均顺利完成。栓塞组手术时间、术中出血量、手术后住院时间、术后血清β-hCG转为正常值的时间分别为(73±14)min,(50±12)mL,(4.9±1.8)d,(24±4)d。开腹组手术时间、术中出血量、手术后住院时间、术后血清β-hCG转为正常值的时间分别为(92±15)min,(85±15)mL,(6.3±1.4)d,(23±3)d。栓塞组与开腹组比较,手术时间、术中出血量、手术后住院时间,差异均有统计学意义(P<0.05),但术后血清β-hCG转为正常值的时间比较,差异无统计学意义(P>0.05)。结论子宫动脉栓塞后清宫术具有术中出血少、住院时间短、恢复快等优点,治疗剖宫产术后子宫瘢痕妊娠效果好,值得有条件的医院推广。

Objective To investigate the feasibility of uterine artery embolization combined withcurettage on treatment of caesarean scar pregnancy（ CSP）. Methods From December 2008 toSeptember 2014, 97 patients with CSP undergoing treatment in the Affiliated Hospital of Qingdao University were studied retrospectively. Forty-eight patients were treated with uterine artery embolizationcombined with curettage（embolization group） , while forty-nine patients were treated bylaparotomyClaparotomy group）. Operative time, intraoperative blood loss, postoperative hospitalizationdays, and the return of ｜3-hCG to normal were compared between the two groups. ResultsAll patients in two groups successfully underwent surgery. In embolization group, the operativetime, intraoperative blood loss, postoperative hospitalization days, and the return of ｜3-hCG to normal were （73 ＋ 14）minutes, （50z tl2）mL, （4. 9 z tl. 8）days, （ 2 4 ＋ 4）days, respectively.While in laparotomy group, these were （92 ＋ 15） minutes, （85z tl5）mL, （6. 3 z tl. 4） days, and （23zb3）days, respectively. Comparing the operative time, intraoperative blood loss, and postoperativehospitalization days, the differences reached statistically significant （P 〈C0. 05） between thetwo groups, however, the difference of the return of ｜3-hCG to normal was not statistically significant（P 〉 0 . 05）between the two groups. Conclusion Uterine artery embolization combined withcurettage could offer advantages including less blood loss, shorter hospitalization time and quickrecovery, and could be much more effective in the treatment of CSP.