子宫动脉栓塞术联合米非司酮在疤痕子宫胎盘前置状态中期妊娠引产中的应用

Application of Uterine Arterial Embolization Combined with Mifepristone in Midtrimester Induction of Labor in Women with Scarred Uterus and Placenta Previa

目的探讨子宫动脉栓塞术(uterine arterial embolization,UAE)联合米非司酮片应用于疤痕子宫胎盘前置状态中期妊娠引产的可行性及优越性。方法回顾性分析2008年1月至2019年1月收治的78例疤痕子宫胎盘前置状态中期妊娠需终止妊娠者的临床资料。其中19例选择剖宫取胎引产(A组),19例选择子宫动脉栓塞术引产(B组:8例自然临产归为B1组;11例非自然临产归为B2组),19例选择子宫动脉栓塞术+米非司酮引产(C组:10例自然临产归为C1组;9例非自然临产归为C2组);21例选择双侧子宫动脉栓塞术+利凡诺+米非司酮引产(D组)。比较6组的各临床指标。结果临产时间:C1组最短为(13.80±5.41)h,C1组短于B1组,B1、C1组短于B2、C2组,D组短于B2、C2组(均P<0.01);产程时间:5组比较差异无统计学意义(P>0.05);产时产后出血量:A组为(800.53±326.93)mL,明显多于其他5组(P<0.01),其他5组间比较差异无统计学意义(P>0.05);子宫破裂发生率:6组比较差异无统计学意义(P>0.05);术后发热发生率:A组2例(10.53%)明显少于其他5组(P<0.01),其他5组间比较差异无统计学意义(P>0.05);术后清宫发生率:D组最高为17例(81%),但与B2、C2组比较差异无统计学意义(P>0.05),而B1、C1组低于其他3组(P<0.05);月经复潮时间:A组最短(约1个月经周期),D组最长(约2.5个月经周期),D组长于B1、C1、A组(均P<0.01);月经复潮时月经量减少率:6组比较差异有统计学意义(P<0.01),其中B1、C1组少于B2、C2、D组(P<0.05);半年后月经量减少率:6组比较差异无统计学意义(P>0.05)。结论UAE是避免疤痕子宫胎盘前置状态中期妊娠引产过程中严重出血的有效方法,联合口服米非司酮更安全、可行、创伤小,能有效终止妊娠且临床效果优于其他方法。

Objective To explore the feasibility and benefits of uterine arterial embolization(UAE)combined with mifepristone in midtrimester induction of labor in women with scarred uterus and placenta previa.Methods Data of 78 pregnant women with scarred uterus and placenta previa from January 2008 to January 2019 for midtrimester induction of labor were analyzed retrospectively.Among these women,the labor was induced by caesarean section in 19(group A),by UAE in 19(group B,8 cases of natural labor(group B1)and 11 cases of unnatural labor(group B2)),by UAE+mifepristone in 19(group C,10 cases of natural labor(group C1)and 9 cases of unnatural labor(group C2)),and by UAE+rivanol+mifepristone in 21(group D).Clinical indices were compared among the six groups.Results The labor time in group C1[(13.80±5.41)hours]was shorter than that in B1,that in group B1 or C1 was shorter than that in group B2 or C2,and that in group D was shorter than that in group B2 or C2(P<0.01).There were no significant differences in labor duration among the five groups and uterine rupture among the six groups(P>0.05).The blood loss during and after labor in group A[(800.53±326.93)mL]was greater than that in other three groups(P<0.01).The incidence of postoperative fever in group A(10.53%,2 cases)was lower than that in other five groups(P<0.01).However,the differences in blood loss and postoperative fever were not significant among the five groups(P>0.05).The postoperative uterine clearance rate was highest in group D(81%,17 cases),and that in group B1 or C1 was lower than that in other four groups(P<0.05).The menstrual recovery time was shortest in group A(about 1 menstrual cycle)and longest in group D(about 2.5 menstrual cycles),and that in group D was longer than that in group B1,C1 or A(P<0.01).The incidence of spanomenorrhea after menstrual recovery in group B1 or C1 was lower than that in group B2,C2 or D(P<0.05).No significant differences in the incidence of spanomenorrhea were found among the six groups after half a year(P>0.05).Conclusion The UAE is an effective method to avoid severe bleeding in midtrimester induction of labor in women with scarred uterus and placenta previa.The combination of UAE and oral mifepristone is safer,more feasible,more effective and less traumatic than other methods for the termination of pregnancy.