子宫动脉栓塞联合宫腔镜治疗剖宫产瘢痕部位妊娠临床分析

Clinical analysis of uterine arterial embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy

目的探讨子宫动脉栓塞联合宫腔镜治疗剖宫产瘢痕部位妊娠的临床疗效。方法选择河南省人民医院2016年9月至2018年3月收治的剖宫产瘢痕部位妊娠患者68例为研究对象,根据治疗方法分为两组。观察组42例,采用先行双侧子宫动脉栓塞术,2~3 d后再行宫腔镜下妊娠病灶电切术。对照组26例,直接行宫腔镜下妊娠病灶电切术。观察两组临床效果。结果观察组失败2例(均为Ⅲ型),其中1例联合腹腔镜行妊娠病灶清除术,1例转行经阴道病灶清除术。对照组失败6例(Ⅰ型1例,Ⅱ型4例,Ⅲ型1例),其中3例术中急诊行子宫动脉栓塞术,其后行宫腔镜手术,2例联合腹腔镜行妊娠病灶清除术,1例Ⅲ型术中出现难以控制的大出血,立即转行开腹手术。观察组手术时间、术中出血量、手术成功率、住院时间、血清β-人绒毛膜促性腺激素恢复正常时间、月经来潮时间、术后阴道出血量、术后阴道出血时间分别为(17.09±3.62)min、(32.6±5.6)mL、95.2%(40/42)、(4.76±1.63)d、(18.00±6.62)d、(30.28±4.23)d、(32.75±8.32)mL、(3.26±1.06)d,对照组分别为(49.51±3.41)min、(60.3±13.6)mL、76.9%(20/26)、(7.23±1.96)d、(22.00±6.91)d、(36.41±7.62)d、(46.23±11.73)mL、(6.42±2.45)d,两组均差异有统计学意义(t=36.68、14.09,χ2=5.189,t=5.62、2.30、4.27、5.54、7.35,均P<0.05)。结论双侧子宫动脉栓塞联合宫腔镜治疗剖宫产瘢痕部位妊娠成功率较高,有手术时间短、出血少、住院时间短、术后恢复快等优点,适用于Ⅰ型与Ⅱ型瘢痕妊娠。

Objective To investigate the clinical efficacy of uterine arterial embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy.Methods From September 2016 to March 2018,68 patients with cesarean scar pregnancy in the People's Hospital of He'nan Province were collected.According to different treatment methods,the patients were divided into observation group and control group.The observation group(42 cases)firstly received bilateral uterine artery embolization,then hysteroscopy pregnancy lesion was resected after 2-3 days.The control group(26 cases)directly received hysteroscopy endoscopic pregnancy lesion resection.Results There were 42 cases in the observation group,2 cases(all of them Ⅲ type)failed,of which 1 case was treated with laparoscopy,and 1 case was converted to transvaginal focus clearance.In the control group,26 cases of cesarean scar pregnancy were treated directly by hysteroscopy,and 6 cases were failed(1 case of type I,4 cases of type Ⅱ,1 case of type Ⅲ),among which 3 cases were treated with uterine artery embolization.Then hysteroscopic surgery was performed in 2 cases,combined with laparoscopy for pregnancy focus debridement.One case of severe hemorrhage occurred in Ⅲ type operation,which was immediately converted to open operation.The operation time,intraoperative blood loss,surgical success rate,length of hospital stay,bloodβ-HCG return to normal time,menstrual recovery time,postoperative vaginal bleeding,postoperative vaginal bleeding time in the observation group were(17.09±3.62)min,(32.6±5.6)mL,95.2%(40/42),(4.76±1.63)d,(18.00±6.62)d,(30.28±4.23)d,(32.75±8.32)mL,(3.26±1.06)d,respectively,which in the control group were(49.51±3.41)min,(60.3±13.6)mL,76.9%(20/26),(7.23±1.96)d,(22.00±6.91)d,(36.41±7.62)d,(46.23±11.73)mL,(6.42±2.45)d,respectively,the differences between the two groups were statistically significant(t=36.68,14.09,χ2=5.189,t=5.62,2.30,4.27,5.54,7.35,all P<0.05).Conclusion Bilateral uterine artery embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy has some advantages including high successful rate,short operation time,less bleeding,hospitalization time and postoperative recovery,etc.It is a safe and effective treatment especially for type Ⅰ and type Ⅱ scar pregnancy.