子宫动脉栓塞术在剖宫产术后瘢痕妊娠患者中的应用价值

Application value of uterine artery embolization in cesarean scar pregnancy patients

目的:探讨剖宫术后瘢痕采用选择性双侧子宫动脉栓塞术的应用价值,分析其临床适用性。方法:回顾性分析2010年3月至2013年11月于我院治疗的92例剖宫产术后子宫瘢痕处妊娠患者的临床资料,根据治疗方式分为观察组(给予选择性双侧子宫动脉栓塞术治疗)和对照组(给予甲氨蝶呤肌内注射治疗)各46例。观察并记录治疗后患者的月经恢复时间、血清β-h CG恢复正常时间等各临床指标,记录患者的不良情况,比较两组患者的治愈率。结果:观察组患者治疗后血清β-h CG恢复正常时间、子宫瘢痕处包块消失时间、手术过程中出血量、住院时长均明显优于对照组(P<0.05),观察组月经恢复正常的时间与对照组比较,差异无统计学意义(P>0.05);观察组患者治疗后治愈率为100%(46/46)明显高于对照组的91.30%(42/46),两组差异比较具有统计学意义(χ2=4.182,P=0.041);观察组患者治疗过程中的不良反应率为10.87%(5/46)明显低于对照组的34.79%(16/46),两组差异比较具有统计学意义(χ2=7.466,P=0.006)。结论:选择性双侧子宫动脉栓塞术后再行宫腔镜下病灶清除术治疗剖宫产术后子宫瘢痕处妊娠,能提高患者的治愈率,降低患者的不良情况,临床效果较显著,值得在临床上进行推广与应用。

Objectives： To investigate the application value of selective uterine artery embolization for caesarean scar,and analyze its clinical applicability. Methods： A retrospective analysis on the clinical data of 92 cesarean scar pregnancy patients in our hospital from March 2010 to November 2013 was conducted,and divided into two groups according to treatment（ administered selective uterine artery embolization treatment） and control group（ given intramuscular injection of methotrexate treatment）,each of 46 cases. After treatment,the menstrual recovery time,recovery time of serum β- h CG and other clinical indicators were recorded,and the adverse reactions and cure rate were compared. Results： The recovery time of serum β- h CG,mass disappearance time of uterine scar,amount of bleeding during surgery,length of hospital stay in observation group was significantly better than the control group（ P〈 0. 05）,while no statistically significant difference was found in recovery time of menstrual period between the two groups（ P〉0. 05）. The cure rate of observation group was 100%（ 46 /46）,significantly higher than the 91. 30（ 42 /46） in control group,with statistically significant difference（ χ2= 4. 1818,P = 0. 0409）.The incidence of adverse events in observation group was 10. 87%（ 5 /46）,significantly lower than the control group of 34. 79%（ 16 /46）,with statistically significant difference（ χ2= 7. 4661,P = 0. 0063）. Conclusion： Selective uterine artery embolization combined with hysteroscopy debridement surgery in the treatment of cesarean scar pregnancy can improve the cure rate and reduce adverse reactions,worthy promotion and clinical applications.