瘢痕子宫妊娠清宫术前后子宫动脉栓塞术对预防子宫切除术的疗效观察

目的分析子宫动脉栓塞术辅助的清宫术治疗38例瘢痕子宫妊娠（CSP）的疗效和安全性，并进一步分析预防性手术和挽救性手术对手术疗效的影响。方法收集因CSP行子宫动脉栓塞术辅助清宫术治疗38例患者的临床资料，其中行预防性手术32例（预防组）、挽救性手术6例（挽救组），以是否进行子宫部分切除术为该研究的主要终点，比较子宫动脉栓塞术前2组CSP患者的基线特征，分析预防性手术与挽救性手术对避免子宫切除术的价值。结果子宫栓塞术前，2组CSP患者的基线特征基本一致，但挽救性子宫动脉栓塞组患者的人绒毛膜促性腺激素（HCG）和血红蛋白水平较低（P〈0．05）。预防性子宫动脉栓塞组患者均安全完成超声引导下清宫术，无一例发生大出血或进行子宫部分切除；挽救性子宫动脉栓塞组有3例因无法止血而进行了子宫部分切除术。两组行子宫部分切除术比例比较差异有统计学意义（P〈0．01）。子宫动脉栓塞术安全性良好，未进行子宫切除的患者约于术后2个月恢复月经。结论子宫动脉栓塞术辅助清宫术应用于CSP患者可以预防清宫术后大出血，且预防性子宫动脉栓塞术对避免子宫切除的疗效明显优于挽救性子宫动脉栓塞术。

Efficacy of preventive and rescue uterine artery embolization in the treatment of cesarean scar pregnan-cy

Objective To evaluate the efficacy and safety of uterine artery embolization （UAE） in the treatment of 38 cases of cesarean scar pregnancy （ CSP）, and further to explore the influence of preventive and rescue UAE upon surgical efficacy. Methods Clinical data from 38 CSP patients receiving UAE were col- lected, 32 cases receiving preventive UAE before uterine curettage （preventive UAE group） and 6 undergoing rescue UAE after uterine curettage （ rescue UAE group）. Whether hysterectomy was performed was regarded as the main endpoint. Baseline characteristics of patients between two groups were statistically compared prior to UAE. The effect of preventive and rescue UAE on the necessity of hysterectomy was evaluated. Results Be- fore UAE, baseline characteristics of patients between two groups were almost the same. However, patients in the rescue group presented with significantly lower human chorionie gonadotropin （HCG） and hemoglobin lev- els compared with their counterparts in the preventive group （ both P 〈 0. 05 ）. Patients receiving preventive UAE successfully underwent ultrasound-assisted uterine curettage. No cases underwent hysterectomy due to se- vere bleeding. In the rescue group, 3 patients received hysterectomy for excessive bleeding. The number of pa- tients undergoing hysterectomy significantly differed between two groups （ P 〈 0. 01 ）. The safety of UAE was assured. Patients who did not undergo hysterectomy had menstruation within postoperative 2 months. Conclu- sion UAE combined with uterine curettage could effectively prevent excessive bleeding. Preventive UAE pres- ented with better effect on avoiding subsequent hysterectomy compared with rescue UAE.