子宫动脉栓塞术应用于子宫瘢痕妊娠清宫的临床疗效

Effects of uterine artery embolization in curettage on cesarean scar pregnancy

目的:探索子宫动脉栓塞术对剖宫产瘢痕妊娠清宫效果的影响及其安全性。方法:回顾性分析80例子宫瘢痕妊娠(CSP)患者的治疗情况,均分为观察组与对照组,观察组采用子宫动脉栓塞术(UAE)联合宫腔镜下清宫术治疗,对照组采用局部药物治疗联合宫腔镜下清宫术。比较两组患者治疗过程中的不良反应、并发症发生情况以及清宫术中出血量、清宫术时间、住院时间,血清促绒毛膜性腺激素(β-HCG)变化情况及其恢复正常水平时间,清宫术后随诊2个月的治疗结局。结果:观察组清宫术中的出血量、清宫术时间与住院时间显著少于对照组(P<0.05);观察组β-HCG恢复正常时间显著少于对照组(P<0.05),下降趋势显著优于对照组;观察组治疗成功率达92.5%,显著高于对照组的60%;观察组术后4例出现不同程度腹部或臀部疼痛、发热,未发生严重并发症;对照组清宫术中7例发生大量阴道出血(>1 500ml),6例患者清宫不全改行病灶切除术。结论:子宫动脉栓塞术应用于子宫瘢痕妊娠的清宫过程可显著提高临床疗效,改善手术结局,降低出血风险,轻微不良反应,减少并发症,具有良好的安全性。

Objective：To explore the effect and safety of uterine artery embolization（UAE）in curettage on cesarean scar pregnancy.Methods：Eighty patients with cesarean scar pregnancy（CSP）were divided into the observation group and the control group averagely,the observation group were treated with hysteroscopic curettage treatment aftre UAE,control group were treated with local drug therapy harem endoscopic curettage.Adverse reactions,complications and the bleeding,uterine curettage time,hospitalization time,the changes of serumβ-HCG and recovery time were compared between two groups.Results：The bleeding,uterine curettage time and hospitalization time in the observation group was significantly lower than that in the control group（P〈0.05）;The time ofβ-HCG restored to normal in observation group was significantly lower than that in the control group（P〈0.05）;The success rate of observation group is 92.5% was significantly higher than that of the control group which was 60%;There were 4cases with different degree of abdominal or hip pain in observation group,and there were no serious complications;seven patients in the control group during curettage with massive vaginal bleeding（〉1 500 ml）,6cases of patients with uterine curettage incomplete diverted lesion resection.Conclusion：UAE in uterine scar pregnancy can significantly improve the clinical efficacy,improve surgical outcomes,reduce the risk of bleeding,decrease adverse reactions and complications.