药物预处理与子宫动脉栓塞术对宫腔镜下清宫术治疗剖宫产瘢痕妊娠疗效的影响

目的：探究药物预处理与子宫动脉栓塞术对宫腔镜下清宫术治疗剖宫产瘢痕妊娠（CSP）疗效的影响。方法：回顾性收集2016年1月-2017年11月河南省信阳市中心医院妇科收治的120例CSP患者的临床资料，根据治疗方法不同分为研究组72例、对照组48例，分别给予米非司酮+甲氨蝶呤（MTX）药物预处理（研究组）、子宫动脉栓塞术干预（对照组），而后实施宫腔镜下清宫术。观察和统计所有患者手术完成情况、术后恢复进度及并发症发生情况。结果：2组患者的二次清宫、大出血、中转开腹、子宫切除发生率比较，差异无统计学意义（P＞0.05）。2组患者手术耗时、术中出血量比较，差异无统计学意义（P＞0.05），但研究组术后住院时间、阴道出血时间、月经恢复时间及血人绒毛膜促性腺激素β亚单位（β-hCG）恢复时间较对照组缩短（P＜0.05）。研究组患者并发症以胃肠道反应为主，发生率为22.22%，高于对照组的7.14%（P＜0.05）；对照组并发症以发热、疼痛为主，发生率分别为18.75%、33.33%，高于研究组的2.78%、8.33%（P＜0.05）；此外，2组感染、肝功能受损、宫腔粘连、子宫穿孔发生率比较，差异无统计学意义（P＞0.05）。结论：宫腔镜下清宫术前给予米非司酮+MTX药物预处理有助于改善CSP患者的临床疗效，术后恢复快，并发症少，但仍应注意胃肠道反应等并发症的防治。

Effect of Pharmacological Preconditioning and Uterine Arterial Embolization on the Curative Effect of Hysteroscopic Uterus Curettage for Cesarean Scar Pregnancy

Objective：To explore the effect of pharmacological preconditioning and uterine arterial embolization on the curative effect of hysteroscopic uterus curettage for cesarean scar pregnancy (CSP). Methods：The clinical data of 120 patients with CSP treated in the department of gynaecology of Xinyang Central Hospital of Henan Province from January 2016 to November 2017 were collected retrospectively. According to different treatment methods, the patients were divided into the study group (72 cases) and the control group (48 cases). The two groups were treated by pharmacological preconditioning with mifepristone + methotrexate (MTX) and uterine arterial embolization, respectively, and then they were treated by hysteroscopic uterus curettage. The completion of operation, postoperative recovery progress and occurrence of complications were observed and statistically analyzed. Results：There was no statistically significant difference in the incidence of secondary uterus curettage, massive hemorrhage, conversion to laparotomy or hysterectomy, operative time or intraoperative blood loss between the 2 groups (P＞0.05). The postoperative length of hospital stay, vaginal bleeding time, menstrual recovery time and blood β-subunit of human chorionic gonadotropin (β-HCG) recovery time of the study group were significantly shorter than those of the control group (P＜0.05). In the study group, the main complications were gastrointestinal reactions, and the incidence rate (22.22%) was significantly higher than that in the control group (7.14%) (P＜0.05). The incidence rates of fever and pain in the control group (18.75% and 33.33%) were significantly higher than those in the study group (2.78% and 8.33%) (P＜0.05). There was no statistically significant difference in the incidence of infection, liver function damage, intrauterine adhesion or uterine perforation between the 2 groups (P＞0.05). Conclusions：The application of pharmacological preconditioning with mifepristone+ MTX before hysteroscopic uterus curettage could improve the clinical curative effect of patients with CSP. Postoperative recovery is fast and complications are few. Attention should be paid to control of complications such as gastrointestinal reactions.