子宫动脉化疗栓塞治疗剖宫产瘢痕妊娠的临床疗效观察

Efficacy of uterine artery chemoembolization in treatment of cesarean scar pregnancy

目的探讨子宫动脉化疗栓塞(UACE)治疗剖宫产瘢痕妊娠(CSP)的临床疗效。方法选取97例行子宫动脉栓塞(UAE)后宫腔镜指引下清宫术的CSP患者为研究对象,所有患者接受UAE后宫腔镜指引下清宫术(腹腔镜监视23例),其中采取UACE(1 000μm明胶海绵栓塞前先经子宫动脉每侧灌注25mg甲氨蝶呤)69例,UAE(1 000μm明胶海绵适量进行栓塞)28例。观察并比较两组患者疗效指标、栓塞及化疗相关不良反应、术后再妊娠情况等。结果两组患者治疗过程顺利,未出现子宫破裂或子宫切除等严重并发症。UACE组均治疗成功;UAE组有2例患者治疗失败,均为Ⅲ型CSP。两组患者清宫术中出血量、术中输血比例、5周内血人绒毛膜促性腺激素(hCG)水平降至正常比例、5周内月经复潮者比例、二次治疗比例比较,均为UACE组优于UAE组(均P<0.05);两组患者术后首次复查血hCG下降比率、住院时间、住院费用、腹腔镜监视比例比较,差异均无统计学意义(均P>0.05)。两组患者栓塞及化疗相关不良反应、术后再妊娠情况比较,差异均无统计学意义(均P>0.05)。结论与UAE相比,UACE后清宫术可减少患者术中出血量,缩短CSP治疗后hCG降至正常的时间及月经复潮时间,提高治愈率,推荐用于Ⅲ型CSP的治疗。

Objective To evaluate the clinical efficacy of uterine artery chemoembolization(UACE) in treatment of cesarean scar pregnancy(CSP). Methods Ninety-seven patients diagnosed as CSP were included in the study. Twenty-eight patients received uterine artery embolization with 1 000μm sponge gelatin(UAE group), 69 patients received additional injection of 25mg methotrexate through each side of uterine artery before UAE(UACE group). Patients underwent hysteroscopy-guided dilation and evacuation(simultaneous laparoscopy guidance was also performed in 23 cases) after uterine artery embolization. The types of CSP, the therapeutic efficacy, the complications related to uterine artery embolization and chemotherapy, and the subsequent pregnancy outcome were compared between two groups. Results Procedures were successfully accomplished in all patients of both groups without uterine rupture or hysterectomy. UAE group had two cases of type Ⅲ CSP who needed extra treatment. UACE group was superior to UAE group in the amount of blood loss during operation, the rate of blood transfusion, the rate of hCG normalization within 5 weeks, the rate of menstruation restoration within 5 weeks, and the extra treatment rate(P<0.05). No differences were found between two groups in hCG decline rate after operation, length of hospital stay, hospitalization expenses, and laparoscopic guidance rate(P >0.05). The complications related to embolization and chemotherapy, and the following pregnancy outcomes were also comparable between two groups(P >0.05). Conclusion For the treatment of CSP, UACE was superior to UAE with less blood loss during operation, faster hCG normalization and menstruation restoration, and lower rate of procedure failure, which can be recommended for the treatment of type Ⅲ CSP.