刮宫术前行预防性子宫动脉栓塞治疗瘢痕妊娠的必要性

Necessity of prophylactic uterine artery embolization before curettage in treatment of cesarean scar pregnancy

目的探讨刮宫术前行预防性子宫动脉栓塞(UAE)治疗瘢痕妊娠(CSP)的必要性。方法收集142例瘢痕妊娠患者,根据Alder分级分为乏血流信号组(0~Ⅰ级,n=40)、较丰富血流信号组(Ⅱ级,n=41)及丰富血流信号组(Ⅲ级,n=61)。采用单纯刮宫术或刮宫术联合术前预防性UAE治疗。分别比较每组中不同治疗方案患者的年龄、剖宫产次数、瘢痕妊娠距上次剖宫产时间、术中出血量及治疗成功率的差异。结果乏血流信号组及较丰富血流信号组中,不同治疗方案在患者年龄、剖宫产次数、距上次剖宫产时间、术中出血量及治疗成功率差异均无统计学意义(P均>0.05)。丰富血流信号组中,刮宫术前预防性UAE的治疗成功率高于单纯刮宫术且术中出血量低于单纯刮宫术(P均<0.05),患者年龄、剖宫产次数、距上次剖宫产时间与单纯刮宫术差异均无统计学意义(P均>0.05)。结论刮宫术前行预防性UAE对孕囊周围血流丰富的瘢痕妊娠患者是必要的,有利于减少术中出血。

Objective To evaluate the necessity of prophylactic uterine artery embolization （UAE） before curettage in treatment of cesarean scar pregnancy （CSP）. Methods A total of 142 patients with CSP were enrolled and divided into 3 groups according to Adler grading standard, including little vascularity （grade 0--I, n = 40）, moderate vascularity （grade II , n=41） and rich vascularity groups （grade III , n=61）. All patients were treated with curettage or prophylactic UAE before curettage. The differences of age, times of cesarean section, time to last cesarean section, intraoperative blood loss and success rate of therapy were compared between different treatment methods in each group. Results There was no sta- tistical difference of age, times of cesarean section, time to last cesarean section, intraoperative blood loss and success rate of therapy between curettage and prophylactic UAE before curettage in little vascularity group and moderate vascularity group （all P〉0.05）. Compared with curettage, the success rate of prophylactic UAE before curettage was higher and the intraoperative blood loss was lower in rich vascularity group （both P〈0.05）. There was no statistical difference of age, times of cesarean section nor time to last cesarean section in rich vascularity group （all P〉0.05）. Conclusion It is neces- sary to perform prophylactic UAE before curettage for cesarean scar pregnancy patient with rich vascularity, which is help- ful to reduction of intraoperative blood loss.