子宫动脉栓塞术联合B超引导下清宫术治疗剖宫产瘢痕妊娠患者的临床效果

Clinical Effect of Uterine Artery Embolization Combined with B-ultrasound-guided Dilatation and Curettage for CSP

目的探讨子宫动脉栓塞术(UAE)联合B超引导下清宫术治疗剖宫产瘢痕妊娠(CSP)患者的临床效果。方法选择2012年1月至2020年12月镇江市第四人民医院收治的100例CSP患者为研究对象,按照手术方式的不同将其分为对照组与试验组,每组50例。对照组采用B超引导下清宫术治疗,试验组采用UAE联合B超引导下清宫术治疗,比较两组手术前后人绒毛膜促性腺激素(HCG)水平、术后子宫内膜厚度、手术相关指标、术后疼痛程度[采用视觉模拟评分法(VAS)评估]、术后并发症发生情况以及手术结局。结果术前,两组HCG水平比较,差异无统计学意义(P>0.05);术后第1天,试验组HCG水平高于对照组,差异有统计学意义(P<0.05);术后第2天,试验组HCG水平低于对照组,子宫内膜厚度大于对照组,差异有统计学意义(P<0.05);试验组术中出血量少于对照组,HCG降低至正常水平用时及住院时间均短于对照组,术后12 h VAS评分低于对照组,差异有统计学意义(P<0.05);两组术后并发症发生率比较,差异无统计学意义(P>0.05);试验组术后妊娠组织残留、大出血、子宫切除及转行宫腔镜手术患者占比均低于对照组,差异有统计学意义(P<0.05)。结论UAE联合B超引导下清宫术治疗剖宫产瘢痕妊娠(CSP)患者的效果显著,具有创伤小、术后并发症发生率低、疼痛程度轻等优势,可最大限度保留患者子宫,促进患者康复。

Objective To investigate the clinical effect of uterine artery embolization(UAE)combined with B-ultrasound-guided curettage in the treatment of patients with cesarean scar pregnancy(CSP).Methods A total of 100 CSP patients admitted to Zhenjiang Fourth People's Hospital from January 2012 to December 2020 were selected as the research objects,and divided into control group and an experimental group according to different surgical methods,with 50 cases in each group.The control group was treated with B-ultrasound-guided curettage,while the experimental group was treated with UAE combined with B-ultrasound-guided curettage.The levels of human chorionic gonadotropin(HCG),endometrial thickness,surgery-related indicators,postoperative pain[assessed by visual analog scale(VAS)],postoperative complications and surgical outcomes were compared between the two groups before and after surgery.Results There was no significant difference in HCG levels between the two groups before operation(P>0.05).The HCG level of the experimental group was higher than that of the control group on the 1st day after operation,with statistically significant differences(P<0.05).On the 2nd day after operation,the HCG level of the experimental group was lower than that of the control group,and the endometrial thickness was greater than that of the control group,and the difference was statistically significant(P<0.05).The amount of intraoperative blood loss in the experimental group was less than that in the control group,the time required for HCG to reduce to normal levels and the length of hospital stay were shorter than those in the control group,and the VAS score at 12 h after operation was lower than that in the control group,with statistically significant differences(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).The proportions of patients with residual pregnancy tissue,massive bleeding,hysterectomy and conversion to hysteroscopy surgery in the experimental group were lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusions UAE combined with B-ultrasound-guided curettage has a significant effect in the treatment of patients with cesarean scar pregnancy(CSP),with the advantages of less trauma,low incidence of postoperative complications and mild pain.It can maximize the preservation of the patient's uterus and promote the recovery.