子宫动脉栓塞术后不同时间行清宫术治疗疤痕妊娠的对比研究

A comparative study of dilation and curettage for cesarean scar pregnancy in different time after uterine arterial embolization therapy

目的对比分析子宫动脉栓塞术后不同时间段行清宫术治疗疤痕妊娠的治疗效果。方法对2014年3月—2016年12月马鞍山市十七冶医院妇产科收治的20例疤痕妊娠患者行子宫动脉栓塞术,根据清宫距离子宫动脉栓塞术(UAE)时间的不同分成3组,分别为栓塞术后24 h内(A组)、24~48 h(B组)、48~72 h(C组)。在超声引导下行清宫术,对术中出血量、住院天数、血清β-HCG下降时间、子宫复旧时间等情况进行监测并对比分析。结果所有病例均一次栓塞成功,A、B、C三组清宫术中出血量分别是(9.3±1.9)ml、(17.1±3.9)ml、(110.0±54.4)ml;住院天数分别是(7.0±2.4)d、(5.9±2.7)d、(11.1±2.1)d;血清β-HCG下降时间分别为(18.6±5.2)d、(19.0±3.3)d、(21.2±4.4)d;子宫复旧时间分别是(41.1±1.1)d、(41.1±1.1)d、(41.5±1.0)d;3组病例中,A、B组较C组出血量明显减少(P<0.01),A、B组住院天数与C组相比明显减少(P<0.01);血清β-HCG下降时间及子宫复旧时间3组差异无统计学意义。结论子宫动脉栓塞术联合超声引导下清宫术治疗子宫疤痕处妊娠具有创伤小、并发症少、疗效确切、能保留子宫的优势,子宫动脉栓塞术后24 h内行清宫术治疗疤痕妊娠是最佳时机。

Objective To compare the clinical outcomes of dilation and curettage at different stages after uterine arterial embolization therapy in the treatment of cesarean scar pregnancy （CSP）. Methods The uterine artery embolization （UAE） was performed in 20 cases of CSP in our hospital between March 2014 and December 2016. According to the time performing uterine curettage after embolization, the patients were divided into Group A （within 24 h）, Group B （24 h to 48 h） and Group C（48 h to 72 h）. The dilation and curettage surgery was performed under the guidance of colored ultrasound. The intraoperative blood loss,length of hospital stay, time to β-HCG recovery and uterine recovery were monitored and analyzed. Results All eases underwent a successful embolization. The intraoperative blood loss of Group A, B and C were （9.3 ± 1.9） ml, （ 17.1 ± 3.9） ml and （ 110.0 ± 54.4） ml, respectively. The length of hospital stay of Group A, B and C were （ 7.0 ± 2.4 ） d, （ 5.9 ± 2.7 ） d and （ 11.1 ± 2.1 ） d, respectively; The time to [3-HCG recovery in Group A, B and C were （ 18.6 ± 5.2 ） d and （ 19.0 ± 3.3 ） d, （21.2 ± 4.4） d, respectively ; The time to uterine recovery in Group A, B and C were （41.1 ± 1.1 ） d, （41.1 ± 1.1 ） d and （41.5 ± 1. 0 ） d, respectively. The intraoperative blood loss of Group A and Group B were significantly lower than that of Group C （P 〈 0.01 ） ;the length of hospital stay in Group A and B were significantly shorter than that in Group C （ P 〈 0. 01 ）. There were no significant differences in the time to β-HCG recovery and uterine recovery among three groups. Conclusion Uterine artery embolization combined with ultrasound guided cu- rettage for uterine scar pregnancy is with less trauma, less complications and curative effect, and can retain the uterus;uterine artery embolization within 24 h after curettage is the best time for the treatment of CSP.