子宫动脉栓塞术对剖宫产瘢痕妊娠大出血患者的再生育的影响

The effect of uterine artery embolization on the reproductive outcome of cesarean scar pregnancy and massive hemorrhage patients

目的评价子宫动脉栓塞术对剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)大出血患者治疗后再次怀孕早期妊娠结局的影响。方法 2010年1月至2018年12月在邯郸市中心医院妇产科住院或门诊收治的剖宫产瘢痕妊娠的214例患者。按是否大出血及治疗方式分为:大出血行子宫动脉栓塞术(uterine artery embolization,UAE)+清宫术(dilation&curettage,D&C)治疗21例(A组),无大出血行UAE+D&C治疗65例(B组),彩超引导下D&C治疗128例(C组),随访3组患者再次怀孕早期妊娠的结局。结果单因素分析显示A组较C组术后宫内妊娠率明显较低(OR=0.26,95%CI:0.10~0.70,P=0.008);再发生CSP(recurrent CSP,RCSP)发生率较高(OR=4.07,95%CI:1.08~15.37,P=0.04);多因素分析结果同样提示A组术后宫内妊娠次数明显低于C组(OR=0.21,95%CI:0.11~0.72,P=0.02)。B组与C组比较,单因素分析显示术后宫内妊娠率差异无统计学意义(OR=0.87,95%CI:0.40~1.89,P=0.72);RCSP发生率较高(OR=3.45,95%CI:1.08~11.02,P=0.04);多因素分析提示术后宫内妊娠率无明显差异。结论与彩超引导下清宫术相比,子宫动脉栓塞术治疗伴有大出血的剖宫产瘢痕妊娠其再次宫内自然妊娠率下降;术后RCSP发生率也可能升高。

Objective To study the effect of massive hemorrhage on the outcome of early pregnancy incesarean scar pregnancy(CSP)patients treated by uterine artery embolization.Methods214 cases of cesareanscar pregnancy were admitted to the gynecology and obstetrics department of Handan central hospital from January2010 to December 2018. Twenty-one cases with massive hemorrhage underwent uterine artery embolization + dilation& curettage(UAE+ D&C)surgery(A group),sixty-five cases without massive hemorrhage underwent UAE+ D&Csurgery(B group),and one hundred and twenty-eight cases with the guidance of color ultrasound underwent D&Csurgery(C group). Follow up the outcome of early pregnancy in three groups.ResultSingle factor analysisshowed that the rate of intrauterine pregnancy in group A was significantly lower than that of group C(OR = 0.26,95% CI:0.10 ~ 0.70,P = 0.008);the rate of recurrent CSP(RCSP)was higher(OR = 4.07,95% CI:1.08 ~15.37,P = 0.04);the results of multi factor analysis also suggested that the number of intrauterine pregnancy ingroup A was significantly lower than that of group C(OR = 0.21,95%CI:0.11 ~ 0.72,P = 0.02). Compared withgroup C,single factor analysis showed that the group B did not have a significant difference in the rate of intrauter-ine pregnancy(OR = 0.87,95%CI:0.40 ~ 1.89,P = 0.72);the incidence of RCSP was higher(OR = 3.45,95%CI:1.08 ~ 11.02,P = 0.04);multivariate analysis showed that there was no significant difference in intrauterinepregnancy rate.ConclusionCompared with the ultrasound-guided dilation & curettage surgery,the rate of reintrauterine natural pregnancy of cesarean scar pregnancy with massive hemorrhage treated by uterine arteryembolization decreased,and the rate of postoperative RCSP may also increase.