剖宫产切口瘢痕妊娠患者采用宫腔镜及子宫动脉栓塞术联合治疗的效果及安全性分析

Analysis of the curative effect and safety of uterine artery embolization combined with hysteroscope in treating cesarean scar pregnancy

目的 探讨剖宫产切口瘢痕妊娠患者（CSP）采用宫腔镜及子宫动脉栓塞术（UAE）联合治疗的效果及安全性分析。方法 选取该院收治的36例CSP患者,入院时均给予宫腔镜及子宫动脉注入甲氨蝶呤（MTX）,在β-人绒毛膜促性腺激素（β-HCG）降至1 000 u/L时,超声显示病灶与浆膜层厚≥0.2 cm时,在宫腔镜下将妊娠病灶切除。结果 UAE联合MTX动脉内注射的手术平均时间（20.12±3.85）min,治疗前后β-HCG水平以及病灶直径均明显降低,分别为[（17 902.74±11 818.23）u/L vs（12 842.73±8 525.73）u/L和（3.65±1.02）cm vs（3.12±0.97）cm],差异有统计学意义（t=8.58,P〈0.01和t=2.26,P〈0.05）;宫腔镜手术平均时间（19.13±2.67）min,平均出血量（17.43±7.28）ml,术后30~45天逐步恢复正常规律月经,疗效满意。结论 采用宫腔镜及UAE对CSP患者进行联合治疗,手术成功率高,术中出血量低,不良反应少,疗效满意。

Objective To explore the curative effect and safety of uterine artery embolization combined with hysteroscope in treating cesarean scar pregnancy. Methods 36 cesarean scar pregnancy patients （CSP diameter under six cm by ultrasound） from June 2014 to June 2015 were selected and studied. All patients received the UAE and arterial injection of Methotrexate （MTX）, and while the blood beta-HCG fell to around 1 000 u/L and the lesions thickness to serous membrane were over 0.2 cm by ultrasound, pregnancy lesions were resected by hysteroscopy surgery. Results The UAE and arterial injection of Methotrexate about （20.12 ± 3.85） min. Blood beta-HCG level and lesion diameter both fell or decreased, each with [（17 902.74±11 818.23） u/L vs （12 842.73 ＋ 8 525.73） u/L and （3.65 ±1.02） cm vs （3.12 ± 0.97） cm] （t = 8.58, P 〈 0.01, t = 2.26, P 〈 0.05）. Hysteroscopy surgery cost about （19.13 ± 2.67） min, the amount of bleeding were （17.43 ±7.28） ml. Postoperative blood beta-HCG decreased to （113.45 ± 36.14） u/L within 2-4 days, the patients were discharged. Conclusion Hysteroscopy surgery with pretreatment of UAE combined with MTX injection could gain satisfactory outcome for patients with CSP. It has high success rate, low blood loss, fewer adverse reactions satisfactory outcome.