子宫动脉栓塞在中期妊娠引产中的应用

Application of uterine artery embolization in midtrimester termination of placenta previa

目的评估子宫动脉栓塞在中期妊娠合并胎盘前置状态引产中的作用。方法对上海国际和平妇幼保健院2007年1月—2017年1月中期妊娠合并完全性胎盘前置状态下引产的33例病例进行回顾性分析,11例引产同时行预防性子宫动脉栓塞+氨甲蝶呤介入治疗作为观察组,另22例引产同时未行预防性子宫动脉栓塞作为对照组,比较2组的基本情况及引产结局,评估预防性子宫动脉栓塞在引产中的作用。电话随访引产后月经恢复情况及再次妊娠情况。采用SPSS 23.0统计软件分析数据。结果①观察组和对照组年龄、孕次、产次、胎盘主体位置、前次剖宫产史、引产方法、感染、引产成功率、胎盘黏连情况比较差异无统计学意义(均P>0.05);观察组引产时间明显长于对照组(P=0.021),引产出血明显少于对照组(P=0.031)。②对照组中有8例引产出血量>300 ml,有4例发生了较严重的出血,急诊行子宫动脉栓塞+氨甲蝶呤介入治疗,均取得良好的效果,保留了患者的生育能力。③电话随访:子宫动脉栓塞病例患者和非子宫动脉栓塞病例患者月经恢复时间比较差异无统计学意义(P=0.093)。结论对于中期妊娠合并完全性胎盘前置状态的患者,引产前预防性应用子宫动脉栓塞能够减少引产出血,子宫动脉栓塞作为引产出血时的急救处理也是安全有效的。子宫动脉栓塞对引产后月经恢复及生育能力无明显影响。

Objective To evaluate the role of uterine artery embolization in midtrimester termination of placenta previa. Methods A retrospective analysis was performed for 33 women with complete placenta previa in midtrimester termination in the International Peace Maternity and Child Health Hospital from January, 2007 to June, 2017. Eleven women induced by prophylactic UAE and MTX therapy as observation group,the other 22 women induced without prophylactic UAE as control group. We compared patient characteristics, intraoperative blood loss and and outcomes. For outpatient, the men- struation recovery was follow-up by telephone after termination of pregnancy. SPSS 23.0 was used to analyze data. Re- sults ① There was no significant difference between the observation group and the control group in the age, gravidity, parity, placenta previa position, previous cesarean section, induced labor method, infection, success rate of induction and placental adhesion（ P 〉 0.05 ）. Comparing the two groups, the prophylactic UAE and MTX therapy can reduce the a- mount of bleeding effectively （P = 0. 031 ） and increase induction time significantly （P = 0. 021 ）. ② The emergency UAE is a very efficacious method during excessive intrapartum bleeding in 4 cases of control group. （③Menstrual recovery time：uterine artery embolization group （lost 1 case） was （51.93 ± 21.24） days, non-uterine artery embolization group （ lost 4 cases） was （40.29 ± 11.43 ） days, P = 0.093. Conclusion Uterine artery embolization is relative safe and ef- fective in the induction of second trimester termination with completely placenta previa. Uterine arterial embolization had no effect on menstrual recovery and fertility after induction of labor.