子宫动脉栓塞术对剖宫产瘢痕妊娠清宫效果的影响及安全性

目的探索子宫动脉栓塞术对剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)清宫效果的影响及安全性。方法回顾性分析2012年3月至2015年10月廊坊市人民医院收治的80例CSP患者的病历资料,按治疗方法不同分为观察组与对照组。观察组采用子宫动脉栓塞术(uterine arterial embolization,UAE)联合宫腔镜下清宫术治疗,对照组采用局部药物治疗后行宫腔镜下清宫术,各40例,比较两组患者清宫过程中的出血量、清宫术时间、不良反应、并发症发生情况、住院时间、血清β-人绒毛膜促性腺激素(beta human chorionic gonadotropin,β-HCG)变化情况及其恢复正常时间,清宫术后随访2月的治疗结局。结果观察组清宫过程中的出血量少于对照组,清宫术时间与住院时间显著短于对照组(P0.05);观察组β-HCG恢复正常时间少于对照组,差异有统计学意义(P0.05);观察组治疗成功率(92.5%)显著高于对照组(60.0%);观察组术后4例出现不同程度腹部或臀部疼痛、发热,未发生严重并发症,对照组清宫过程中7例发生大量阴道出血(1 500 m L),6例患者清宫不全改行病灶切除术。结论 UAE应用于CSP清宫可显著提高临床疗效,改善手术结局,减少出血风险,且不良反应轻微,并发症少,具有良好的安全性。

Effect of uterine arterial embolization on the effect of uterus clearing of cesarean section scar pregnancy and its safety

Objective To explore the effects of uterine arterial embolization ( UAE) on uterus clearing cesarean scar pregnancy (CSP) and its safety. Methods Data of 80 patients with CSP in Langfang City People's Hospital from March 2012 to October 2012 were retrospectively analyzed. They were divided into observation group(40) and control group(40) according to different treatment. The observation group were treated by UAE combined with hysteroscopy, the control group were treated with hysteroscopy after topical medications. The amount of bleeding, operation time, adverse reactions, complications, hospital stay, serum concentration of beta human chorionic gonadotropin (β-HCG) and time of recovery were compared between the two groups. The outcome of the treatment was followed up for 2 months. Results The amount of bleeding in operation of the observation group was less than that of the control group, and the time of hospitalization was significantly shorter than that of the control group, the difference had statistical significance (P< 0. 05);The time of β-HCG returned to normal in the observation group was less than that of the control group, the difference was statistically significant ( P< 0. 05 ); The success rate of observation group ( 92. 5%) was significantly higher than that of the control group (60%);In the observation group, there were 4 cases of abdominal or hip pain, fever, but without serious complications. In the control group, 7 cases had large number of vaginal bleeding( >1 500mL), 6 patients with incomplete removal were diverted to lesion resection. Conclusion UAE applied in the CSP uterus clearing can significantly improve the clinical curative effect, improve surgical outcomes, reduce bleeding risk, with mild adverse reactions, fewer complications and good safety.