子宫动脉栓塞术对有生育要求的子宫疤痕妊娠患者的治疗价值

Value of uterine artery embolization in the treatment of uterine scar pregnancy patients with fertility requirements

目的探讨子宫动脉栓塞术(UAE)对有生育要求的子宫疤痕妊娠患者的治疗价值。方法 40例子宫疤痕妊娠患者,根据自愿原则随机分为治疗组与对照组,每组20例。治疗组行UAE+宫腔镜电切术,对照组行宫腔镜检查+B超引导下清宫术。对比两组的治疗效果。结果两组手术均取得成功,治疗组术中出血量为(6.50±2.35)ml,少于对照组的(20.00±11.24)ml;术后阴道流血时间、住院时间及血人绒毛膜促性腺激素(HCG)转阴时间分别为(2.10±0.72)、(5.90±0.72)、(12.40±1.93)d,均短于对照组的(9.20±2.29)、(11.25±1.86)、(37.85±6.78)d,差异均具有统计学意义(P<0.05)。治疗组术后月经量减少发生率50.0%和宫腔粘连发生率30.0%均高于对照组的15.0%、5.0%,差异均具有统计学意义(P<0.05)。结论 UAE在子宫疤痕妊娠的治疗中能显著降低大出血的风险,是安全有效的治疗方法。但术后宫腔粘连发生率极高,影响患者生育功能,对仍有生育要求的患者,应慎重选用。

Objective To explore the value of uterine artery embolization （UAE） in the treatment of uterine scar pregnancy patients with fertility requirements. Methods A total of 40 uterine scar pregnancy patients were divided by voluntary principal into treatment group and control group, with 20 cases in each group. The treatment group received UAE ± uteroscope electrotomy, and the control group received hysteroscopy examination ± ultrasound guided curettage. Therapeutic effect was compared in two groups. Results Both groups had successful operation, and the treatment group had less intraoperative bleeding volume as （6.50 ± 2.35） ml than （20.00 ± 11.24） ml in the control group, and shorter postoperative vaginal bleeding time, hospital stay time and human chorionic gonadotropin （HCG） negative conversion time as （2.10 ± 0.72）, （5.90 ± 0.72） and （12.40 ± 1.93） d than （9.20 ± 2.29）, （11.25 ± 1.86） and （37.85 ± 6.78） d in the control group. Their difference had statistical significance （P〈0.05）. The treatment group had higher incidence of postoperative reduced menstrual quantity as 50.0% and incidence of intrauterine adhesion as 30.0% than 15.0% and 5.0% in the control group, and their difference had statistical significance （/9〈0.05）. Conclusion UAE can significantly reduce risks of massive haemorrhage in treating uterine scar pregnancy, and it is a safe and effective treatment method. But it has high incidence of postoperative intrauterine adhesion that can affect reproductive function of patients. So patients with fertility requirements should chosen it carefully.