剖宫产瘢痕妊娠病灶切除术与子宫动脉栓塞术后清宫的效果比较

目的 比较剖宫产瘢痕妊娠病（CSP）灶切除与子宫动脉栓塞后清宫的临床效果。方法 回顾性分析2015年1月~2018年6月我院收治的110例剖宫产瘢痕妊娠患者的临床资料，根据手术方式分为手术组（52例）和清宫组（58例），手术组行瘢痕病灶切除术，清宫组同期行子宫动脉栓塞后清宫，比较两组术中出血量、血HCG下降至正常的时间、住院费用及术后第1次月经量改变情况。结果 手术组平均出血量为（80.59±17.12）ml，高于清宫组的（8.65±1.53）ml，差异有统计学意义（P＜0.05）；手术组血HCG下降至正常时间为（22.40±7.45）d，少于清宫组的（31.80±8.24）d，差异有统计学意义（P＜0.05）；两组住院费用比较，差异无统计学意义（P＞0.05）；清宫组有9例出现术后第1次月经量减少，手术组无患者发生月经量改变。结论 瘢痕妊娠病灶切除与子宫动脉栓塞后清宫的住院费用相当，但子宫动脉栓塞后清宫有瘢痕持续存在、术后血HCG下降缓慢、部分患者出现月经量减少的缺点，故对于肌壁厚度＜4 mm，有再生育要求的CSP患者，瘢痕病灶切除术应作为首选的治疗措施。

Comparison of the Effect of Cesarean Scar Pregnancy Resection and Uterine Artery Embolization

Abstract:Objective To compare the clinical effects of cesarean scar pregnancy resection and uterine artery embolization.Methods The clinical data of 110 patients with cesarean scar pregnancy admitted to our hospital from January 2015 to June 2018 were retrospectively analyzed. According to the surgical procedure, they were divided into operation group (52 cases) and Qinggong group (58 cases). The scar was resected, and the uterine artery embolization was performed in the Qinggong group. The intraoperative blood loss, blood HCG decreased to normal time, hospitalization cost and the change of menstrual volume after operation was compared.Results The mean bleeding volume in the operation group was (80.59±17.12) ml, which was higher than that in the Qinggong group (8.65±1.53) ml,the difference was statistically significant (P<0.05). The blood HCG in the operation group decreased to the normal time (22.40±7.45) d, less than the Qinggong group (31.80 ± 8.24) d, the difference was statistically significant (P<0.05); the difference between the two groups of hospitalization costs, the difference was not statistically significant (P>0.05);9 cases of the Qinggong group after the operation the first menstrual flow was reduced, and no changes in menstrual flow occurred in the surgery group.Conclusion The cost of hospitalization for sacral pregnancy resection and uterine artery embolization is equivalent to that of uterine artery embolization. However, there is a scar in the uterus after embolization of the uterus, and the blood HCG declines slowly after operation. Some patients have the disadvantage of reducing menstrual flow, so the thickness of the muscle wall is less than 4 mm, CSP patients with re-fertility requirements, scar lesion resection should be the preferred treatment.