双侧子宫动脉栓塞术联合清宫术治疗剖宫产瘢痕子宫妊娠的疗效分析

Effect of bilateral uterine artery embolization combined with curettage in the treatment of cesarean scar uterine pregnancy

目的探讨剖宫产瘢痕子宫妊娠治疗中采用双侧子宫动脉栓塞术联合清宫术的临床疗效。方法前瞻性选取2019年7月至2021年7月同济大学附属第一妇婴保健院收治的98例患者,采用随机数字表法分为清宫组49例和子宫动脉栓塞+清宫组49例。清宫组接受超声引导下联合清宫术,子宫动脉栓塞+清宫组接受双侧子宫动脉栓塞术联合清宫术。比较两组患者的临床疗效;对比两组患者术中出血量、手术时间、人绒毛膜促性腺激素(HCG)转阴时间、住院时间、阴道流血时间、月经恢复正常时间、生活质量评分及术后不良情况。结果子宫动脉栓塞+清宫组总有效率为97.96%,明显高于清宫组(81.63%),差异有统计学意义(P<0.05)。子宫动脉栓塞+清宫组的术中出血量、手术时间、住院时间为(38.26±4.16)mL、(25.31±5.12)d、(4.51±1.41)d,均低于清宫组[(76.38±6.27)mL、(131.24±14.41)d、(8.62±1.77)d],差异均有统计学意义(P<0.05)。子宫动脉栓塞+清宫组患者的HCG转阴时间、月经恢复正常时间、阴道流血时间为(19.48±2.68)、(7.93±1.16)、(29.56±6.94)d,均明显低于清宫组[(26.11±4.27)、(12.63±2.17)、(44.28±7.35)d],差异均有统计学意义(P<0.05)。子宫动脉栓塞+清宫组患者的社会关系情况、心理情况、生理情况评分为(83.86±8.12)、(85.46±8.14)、(87.66±8.15)分,均明显高于清宫组[(70.24±6.11)、(68.37±6.37)、(71.21±5.73)分],差异均有统计学意义(P<0.05)。子宫动脉栓塞+清宫组术后并发症总发生率为8.16%,明显低于清宫组(18.37%),差异有统计学意义(P<0.05)。结论双侧子宫动脉栓塞术联合清宫术治疗剖宫产瘢痕子宫妊娠具有术中出血少和创伤小的优点,并能有效减少并发症,患者恢复时间短,能提高治疗有效率。

Objective To investigate the curative effect of bilateral uterine artery embolization combined with uterine evacuation for uterine pregnancy scarred by cesarean section.Methods From July 2019 to July 2021,98 patients were admitted to the Department of Gynecology,Shanghai First School of Medicine Maternity and Infant Hospital,Tongji Universit,and were randomly divided into 49 cases in the uterine purging group and 49 cases in the uterine artery embolization+curettage group.The curettage group was received ultrasound-guided combined uterine evacuation and the uterine artery embolization+curettage group was received bilateral uterine artery embolization combined with uterine evacuation.The efficacy of the two groups was compared;the amount of blood loss,operation time,human chorionic gonadotropin(HCG)negative time,hospitalization time,vaginal bleeding time,time to normal menstruation,social relations,psychological status,and physiological status between the two groups and postoperative adverse conditions were compared.Results The total effective rate of uterine artery embolization+curettage group was 97.96%,which was significantly higher than that of curettage group(81.63%),the difference was statistically significant(P<0.05).The amount of intraoperative bleeding,operation time and hospital stay in uterine artery embolization+curettage group were(38.26±4.16)mL,(25.31±5.12)d,(4.51±1.41)d,which were lower than those in curettage group[(76.38±6.27)mL,(131.24±14.41)d,(8.62±1.77)d],the differences were statistically significant(P<0.05).The time of HCG turning negative,the time of menstruation returning to normal and the time of vaginal bleeding in the uterine artery embolization+curettage group were(19.48±2.68)d,(7.93±1.16)d,(29.56±6.94)d,which were significantly lower than those in the curettage group[(26.11±4.27)d,(12.63±2.17)d,(44.28±7.35)d],the differences were statistically significant(P<0.05).The scores of social relationship,psychological condition and physiological condition of patients in uterine artery embolization+curettage group were(83.86±8.12)points,(85.46±8.14)points,(87.66±8.15)points,which were significantly higher than those in curettage group[(70.24±6.11)points,(68.37±6.37)points,(71.21±5.73)points],the differences were statistically significant(P<0.05).The total incidence of postoperative complications in uterine artery embolization+curettage group was 8.16%,which was significantly lower than that in curettage group(18.37%),the difference was statistically significant(P<0.05).Conclusion Bilateral uterine artery embolization combined with uterine evacuation has the advantages of less intraoperative bleeding and less trauma,and can effectively reduce complications and preserve fertility.