甲氨蝶呤联合子宫动脉栓塞术后定点吸胚术治疗剖宫产术后子宫瘢痕妊娠51例临床分析

目的:探讨甲氨蝶呤(MTX)预处理联合子宫动脉栓塞术(UAE)后超声引导下定点吸胚术治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床疗效和最佳给药方法。方法:回顾性分析首都医科大学附属朝阳医院2011年1月—2014年12月收治的采用MTX预处理联合UAE后超声引导下定点吸胚术治疗的51例CSP患者资料,按MTX不同给药方式分为3组。A组(23例):MTX全身用药后行UAE,然后行定点吸胚术;B组(11例):MTX子宫动脉灌注化疗栓塞(UACE)后行定点吸胚术;C组(17例):MTX全身用药联合UACE,再行定点吸胚术。比较各组患者的基本信息、治疗前情况和术中情况,并评估治疗效果指标。结果:3组患者均一次性手术成功,无需腹腔镜手术等二次处理,无膀胱损伤、子宫穿孔和子宫切除等并发症发生。3组患者出血量、手术时间、血清人绒毛膜促性腺激素β亚单位(β-hCG)转阴时间、包块吸收时间、手术成功率和并发症发生率比较,差异无统计学意义(均P>0.05)。B组的住院时间和住院费用较另2组减少,差异有统计学意义(均P<0.05)。孕囊或包块最大直径在Logistic回归模型中有统计学意义(OR=1.094,95%CI:1.012～1.183,P=0.024)。结论:MTX预处理联合UAE后定点吸胚术疗效确切、手术难度小、创伤小且花费少,可广泛用于治疗内生型和外生型CSP,推荐UACE作为术前预处理的首选方式,该方法对于病灶最大直径<4.3 cm的患者更安全。

Analysis of 51 Cases of Cesarean Scar Pregnancy Treated with Suction Curettage under Ultrasound Guidance after Methotrexate Treatment Combined Uterine Artery Embolization

Objective：To evaluate the effect and the best administration of suction curettage under ultrasound guidance after methotrexate (MTX) treatment combined uterine artery embolization(UAE) for cesarean scar pregnancy (CSP). Methods：This was a retrospective case study of 51 cases who were diagnosed as CSP and treated by suction curettage under transabdominal ultrasound guidance after MTX treatment combined uterine artery embolization as an initial treatment of CSP in Chaoyang Hospital, Capital Medical University from January 2011 to December 2014. 51 patients were divided into three groups. Group A (23 cases): MTX systemic administration followed by UAE, and then fixed-point suction surgery. Group B (11 cases): Uterine arterial chemoembolization (UACE) followed by fixed-point suction surgery. Group C (17 cases): MTX systemic administration combined with UACE, and then fixed-point suction surgery. The basic information, the situation before treatment, intraoperative situation and assessment of therapeutic effect indicators of each group of patients were compared. Results：The three groups of patients were all one-time successful operation, with no secondary processing such as laparoscopic surgery. There was no case of bladder injury, uterus perforation and hysterectomy. The three groups in operation time, intraoperative blood loss, β-hCG to normal time, lesion absorption time, the success rate and the incidence of complications had no statistical significance (both P＞0.05). The hospitalization time and expenses in group B compared with the other two groups were decreased significantly (both P＜0.05). The maximum diameter of gestational sac or mass in Logistic regression model was statistically significant (OR=1.094, 95%CI: 1.012-1.183, P=0.024). Conclusions：Suction curettage under transabdominal ultrasound guidance after MTX treatment combined uterine artery embolization is safe and effect. It can be widely used in the treatment of endogenous and exogenous CSP. UACE is recommended as the preferred method for preoperative pretreatment. It is more security for patients whose lesions biggest diameter is less than 4.3 cm.