子宫动脉化疗栓塞术、甲氨蝶呤分别联合清宫术治疗剖宫产子宫瘢痕妊娠的效果

Effect of uterine artery embolization and methotrexate respectively combined with uterine curettage in the treatment of cesarean scar pregnancy

目的探究子宫动脉化疗栓塞术(uterine artery embolization,UAE)、甲氨蝶呤(methotrexate,MTX)分别联合清宫术在剖宫产子宫瘢痕妊娠(cesarean scar pregnancy,CSP)患者中的应用价值。方法回顾性分析行保守治疗的CSP患者142例,根据保守治疗方式不同分为观察组(72例,UAE联合清宫治疗)和对照组(70例,MTX联合清宫治疗),比较2组临床治疗经过、结局及术后SF-36量表评分与不良反应。结果2组保守治疗的成功率、子宫切除率及病灶切除率比较差异无统计学意义(P<0.05);观察组的手术时间、术中出血量、住院时间、人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-hCG)复常时间、孕囊消失时间和阴道出血时间均短于对照组。观察组住院费用、月经复潮时间多(短)于对照组(P<0.05);观察组治疗后3、6个月的SF-36生活质量量表评分明显高于对照组(P<0.01);观察组不良反应的发生率(4.17%)低于对照组(15.71%),P<0.05。结论子宫动脉化疗栓塞术联合清宫术与甲氨蝶呤肌肉注射联合清宫术治疗CSP的疗效相似。子宫动脉化疗栓塞术联合清宫术可明显缩短手术时间、孕囊消失时间、阴道出血时间及β-HCG复常时间,减少术中出血量,安全性高,对提高患者的生活质量有益,但住院费用较高,因此2种保守治疗方案均有一定适用性,临床可根据实际情况选择。

Objective To investigate the application value of uterine artery embolization(UAE)and methotrexate(MTX)respectively combined with uterine curettage in the treatment of cesarean scar pregnancy(CSP).Methods A total of 142 patients with CSP were divided into an observation group(72 patients treated with UAE and uterine curettage)and a control group(70 patients treated with MTX and uterine curettage).The clinical treatments,treatment outcomes,postoperative SF-36 score,and adverse reactions were compared between the 2 groups.Results There was no significant difference in the success rate of conservative treatment,hysterectomy rate or lesion excision rate between the groups(P>0.05).The operation time,intraoperative blood loss,length of hospital stay,recovery time ofβ-human chorionic gonadotropin(β-hCG),disappearance time of gestational sac,and vaginal bleeding time in the observation group were shorter/less than those in the control group.The hospitalization cost and menstrual recovery time were higher/longer than those in the control group(P<0.05).The observation group had significantly higher SF-36 scores than the control group at 3 and 6 months after treatment(P<0.01).The incidence of adverse reactions in the observation group(4.17%)was lower than that in the control group(15.71%)(P<0.05).Conclusion Uterine artery chemoembolization combined with uterine curettage and methotrexate intramuscular injection combined with uterine curettage can achieve similar curative effect in the treatment of CSP.The former can significantly shorten the operation time,the disappearance time of gestational sac,vaginal bleeding time,and the recovery time ofβ-hCG,and reduce intraoperative blood loss,with high safety,which is beneficial to the improvement of quality of life,but the hospitalization cost is high.In clinical practice,the 2 conservative treatments can be selected according to the actual situation.