双侧子宫动脉栓塞与甲氨蝶呤肌注联合宫腔镜电切术治疗瘢痕子宫妊娠的效果

Effects of bilateral uterine artery embolization and methotrexate intramuscular injection combined with hysteroscopic electrotomy for scar uteru pregnancy

目的对比双侧子宫动脉聚乙烯醇(PVA)栓塞与甲氨蝶呤(MTX)肌注联合宫腔镜电切术治疗瘢痕子宫妊娠的临床效果。方法对86例瘢痕子宫妊娠患者的临床资料进行回顾性分析。按照治疗方案不同分为PVA栓塞组(n=46,实施双侧子宫动脉PVA栓塞)和MTX肌注组(n=40,实施MTX肌注),随后均进行宫腔镜电切术,比较两组临床效果。结果 PVA栓塞组46例均治疗成功,MTX肌注组37例治疗成功。PVA栓塞组的血β-HCG转阴时间、腹部包块消失时间及总住院时间均显著短于MTX肌注组(P<0.05)。两组不良反应总发生率无显著差异(P>0.05)。结论双侧子宫动脉PVA栓塞联合宫腔镜电切术治疗瘢痕子宫妊娠的临床疗效显著,且并发症少。

Objective To compare the clinical effects of bilateral uterine artery polyvinyl alcohol （PVA） embolization andmethotrexate （MTX） intramuscular ＋hysteroscopic electrotomy in the treatment of scar uterus pregnancy. Methods Theclinical data of 86 patients with scar pregnancy were retrospectively analyzed. They were divided into PVA embolizationgroup （n=46, given bilateral uterine artery PVA embolization） and MTX intramuscular injection group （n=40, given MTXintramuscular injection） according to different treatment programs, both followed by hysteroscopic resection. The clinicaleffects in the two groups were compared. Results All the 46 patients in the PVA embolization group were treatedsuccessfully. In the MTX intramuscular injection group, 37 patients were successfully treated. The blood β-HCG negativetime, abdominal mass disappearance time and total hospital stay in the PVA embolization group were significantly shorterthan those of the MTX intramuscular injection group （P〈0.05）. There was no significant difference in the total incidence ofadverse reactions between the two groups （P〉0.05）. Conclusion The bilateral uterine artery PVA embolization combinedwith hysteroscopic electrotomy is effective in scar uterus pregnancy, with fewer complications.