超选择性子宫动脉栓塞术、妊娠病灶清除术、瘢痕修补术联合治疗剖宫产瘢痕妊娠的临床研究

Clinical study on super-selected uterine arterial embolization combined with gestational lesion removal and scar repair in the treatment of cesarean scar pregnancy

目的 研究超选择性子宫动脉栓塞术＋妊娠病灶清除术＋瘢痕修补术治疗剖宫产瘢痕妊娠的临床价值.方法 选取34例剖宫产瘢痕妊娠患者为研究对象,按治疗方案的不同将患者分为观察组和对照组,每组17例,观察组采用超选择性子宫动脉栓塞术＋妊娠病灶清除术＋瘢痕修补术,对照组采用妊娠病灶清除术＋瘢痕修补术,比较两组患者的术中、术后情况以及恢复情况.结果 观察组术中出血量、住院时间、血人绒毛膜促性腺激素（HCG）降至正常时间分别为（62.5±21.7）ml、（6.0±2.6）d、（22.2±6.2）d,显著低于对照组的（94.4±34.0）ml、（8.8±3.3）d、（27.6±8.4）d,P＜0.05）;观察组总费用为（18 241.5±5 217.2）元,显著高于对照组的（10 734.8±3 478.1）元,P＜0.05.结论 超选择性子宫动脉栓塞术＋妊娠病灶清除术＋瘢痕修补术治疗剖宫产瘢痕妊娠可以有效预防大出血,保护子宫,是一种较理想的治疗方案.

Objective To study the clinical value of super-selected uterine arterial embolization combined with gestational lesion removal and scar repair on cesarean scar pregnancy.Methods Thirty-four patients with cesarean scar pregnancy were selected as study subjects and were divided into observation group and control group according to different treatment plans, with 17 cases in each group. The observation group was treated by super-selected uterine arterial embolization combined with gestational lesion removal and scar repair, while the control group was treated by gestational lesion removal combined with scar repair. The intraoperative and postoperative condition and recovery were compared between the two groups.Results The intraoperative blood loss, hospitalization time and time of blood HCG decreasing to normal level in the observation group [（62.5±21.7） ml, （6.0±2.6） d, （22.2±6.2） d ] were significantly lower than those in the control group [（94.4±34.0） ml, （8.8±3.3） d, （27.6±8.4） d, P〈0.05]. The total cost of the observation group [（18 241.5±5 217.2） yuan] was significantly more than that of the control group [（10 734.8±3 478.1） yuan, P〈0.05）].Conclusions Super-selected uterine arterial embolization combined with gestational lesion removal and scar repair can effectively prevent massive hemorrhage and protect the uterus. It is an ideal treatment method.