子宫动脉灌注MTX与栓塞后清宫用于子宫瘢痕妊娠的临床疗效观察

Clinical efficacy of uterine artery embolizationcombined with intra-arterial methotrexate following uterine curettage of caesarean scar pregnancy

目的探讨子宫动脉栓塞术(uterine artery embolization,UAE)在子宫瘢痕妊娠治疗中的临床价值。方法选择北海市人民医院2017年3月至2019年3月收治的子宫瘢痕妊娠30例,进行前瞻性研究,随机分成两组。观察组15例:UAE组采用Seldingers方法,经双侧子宫动脉灌注甲氨蝶呤(methotrexate,MTX)50 mg,再用明胶海绵颗粒行双侧子宫动脉栓塞。72 h内B超引导下行清宫术。对照组15例:全身用药组,MTX 20 mg im qd×5 d,用药5 d后立即B超引导下行清宫术。记录患者术前、术后人绒毛膜性腺激素(human chorionic gonadotropin HCG)、肝肾功能、术中出血量。结果1.治疗前HCG与清宫前HCG下降倍数:(治疗前HCG:指行介入治疗前、全身用MTX前的HCG值)/(清宫前HCG:指UAE术后及全身用MTX后的HCG值),UAE组为(6.57±14.06)倍,全身用药组为(1.57±1.36)倍,UAE组比全身用药组下降倍数更多,差异有统计学意义(P=0.031)。2.治疗前HCG与清宫后HCG下降倍数(治疗前HCG/清宫后HCG):UAE组为(29.61±50.87)倍,全身用药组为(15.66±15.87)倍,UAE组比全身用药组下降更多,但是差异无统计学意义(P=0.337)。3.清宫出血量:UAE组为(7.47±7.43)mL,全身用药组为(31.67±80.40)mL,UAE组少于全身用药组,差异有统计学意义(P=0.042)。4.肝肾功能变化:UAE组转氨酶升高0例,全身用药组转氨酶升高4例。结论子宫动脉灌注MTX与栓塞后清宫CSP,HCG值下降倍数更多,术中出血更少,肝肾功能影响小,是提高子宫瘢痕妊娠治疗疗效、减少清宫术后出血的有效方法。

Objective To explore the clinical value of uterine artery embolization(UAE)in the treatment of caesarean scar pregnancy(CSP).Methods 30 patients with CSP from March 2017 to March 2019 in Beihai People's Hospital were randomized divided into two groups.Observation group(UAE group,n=15):the uterine arteries of UAE group were performed using gelfoam particles following intra-arterial infusion of 50 mg methotrexate(MTX)by Seldingers.Uterine curettage was performed by ultrasonography within 72 hours.Control group(n=15):patients received intramuscular MTX injection(20 mg im qd×5 d)and subsequent uterine curettage by ultrasonography.Preoperative and postoperative serum HCG,hepatic or renal function and intraoperative hemorrhage of two groups were recorded as outcome endpoints.Results The decreased ratio of HCG before treatment and HCG before uterine curettage(HCG before treatment/HCG before uterine curettage):UAE group was(6.57±14.06)times,control group was(1.57±1.36)times,the decreased ratio of HCG was lower in UAE group,the difference was statistically significant(P=0.031).The decreased ratio of HCG before treatment and HCG before uterine curettage(HCG before treatment/HCG before uterine curettage):UAE group was(29.61±50.87)times,control group was(15.66±15.87)times,the decreased ratio of HCG was lower in UAE group,but the difference was not statistically significant(P=0.337).Intraoperative hemorrhage:UAE group was(7.47±7.43)mL,control group was(31.67±80.40)mL,The intraoperative hemorrhage of UAE group was smaller,and the difference was statistically significant(P=0.042).Hepatic and renal function:there were none case of increased transaminase in UAE group,4 cases in control group.Conclusions UAE combined with intraarterial MTX infusion following uterine curettage could reach lower decreased ratio of HCG,smaller intraoperative hemorrhage and less hepatic or renal failure,and it turned out to be an more effective and less intraoperative hemorrhage treatment for CSP.