刮宫术前行子宫动脉栓塞术治疗347例子宫瘢痕妊娠的临床价值研究

目的：探讨于刮宫术前行子宫动脉栓塞术治疗子宫瘢痕妊娠的临床价值及其中的技术要点。 方法：选取2012年1月至2017年1月我科收治的子宫瘢痕妊娠患者共347例,使用可吸收明胶海绵颗粒"层叠式"栓塞子宫供血动脉,并在栓塞术后72 h内于超声监测下完成刮宫术。分析患者数字减影血管造影（DSA） 结果、子宫动脉栓塞手术结果、栓塞后疼痛情况、刮宫术中出血量及随访资料。结果：347例患者均成功接受造影检查,其中343例成功进行栓塞术,技术成功率98.85%（343/347）。4例患者造影检查后未实施栓塞治疗。347例中有22例存在异生血管,占6.34%;有异生血管的患者刮宫术中出血量高于无异生血管者。347例患者均成功在超声监视下行刮宫术,刮宫术中出血量10~2000 ml,其中302例出血量≤50 ml,33例50~600 ml,12例≥600 ml。栓塞后≤24 h行刮宫术者74例,24~48 h 234例,48~72 h 39例。栓塞后不同时间段行刮宫术的出血量差异无统计学意义。妊娠6周内与7~9周的刮宫术中出血量无统计学意义;而妊娠10~12周刮宫术中的出血量明显大于妊娠9周以内的患者,差异有统计学意义。321例患者栓塞术后下腹部疼痛程度轻微,无需药物处理。栓塞术后卵巢功能未受到明显影响。 结论：术前72 h内预先栓塞子宫供血动脉能有效预防刮宫术中大出血,且未明显影响到卵巢功能。

Clinical value of uterine artery embolization before uterine curettage with cesarean scar pregnancy

Objective:To investigate the clinical value and technical essentials of uterine arterial embolization before curettage in patients with cesarean scar pregnancy. Methods:A total of 347 patients with cesarean scar pregnancy from January 2012 to January 2017 were collected and treated with "layered" absorbable gelatin sponge particles to embolize the uterine artery, and curettage was performed under ultrasound scanning within 72 h after embolization. The results of digital subtraction angiography (DSA) and embolization, the pain after embolization, the amount of bleeding in curettage and the related follow-up data were analyzed. Results:Among the 347 patients who successfully received DSA, embolization was successfully performed in 343 cases. The technical success rate was 98.85% (343/347) . Four cases were not treated with embolization after DSA. Among the 347 cases, 22 cases had abnormal blood vessels, accounting for 6.34%. And the patients with heterogeneous blood vessels had higher blood loss than those with undifferentiated blood vessels. The 347 patients were successfully performed with curettage under ultrasound scanning, the amount of bleeding in curettage was 10-2 000 ml. Among the 347 patients, 302 cases were less than 50 ml, 33 cases were 50-600 ml, and 12 cases were more than 600 ml. After embolization, 74 cases were treated within less than 24 h, 234 cases were treated within 24-48 h, and 39 cases were within 48-72 h. There was no statistically significant difference in the amount of blood loss at different time intervals after embolization. There was no significant difference in the amount of blood loss between the 6th week of pregnancy and the 7th to 9th week of curettage. The amount of blood loss in the curettage at 10 to 12 weeks of pregnancy was significantly greater than that of patients within 9 weeks of pregnancy. The difference was statistically significant. Conclusion:Pre-embolization of the uterine feeding artery within 72 h before surgery can effectively prevent major bleeding during curettage and does not significantly affect ovarian function.