子宫动脉灌注化疗加栓塞术治疗剖宫产瘢痕妊娠的疗效分析

目的探讨子宫动脉灌注化疗加栓塞术治疗剖宫产瘢痕妊娠的治疗效果及安全性。方法将42例剖宫产瘢痕妊娠患者随机分为2组，A组采用子宫动脉灌注化疗加栓塞术治疗，术后3天在B超监测下行清宫术；B组采用MTX加米非司酮全身用药，待血B—HCG下降低于200IU／L后在B超监测下行清宫术。观察2组住院天数、清官术中出血量、血B—HCG下降情况及月经恢复情况。结果A组21例患者住院天数（11．2±1．7）天，清宫术中出血量（35．2±18．4）ml，血B—HCG下降至正常时间（21．2±3．5）天，术后月经恢复时间（30．0±4．0）天；B组21例患者住院天数（20．6±5．6）天，清宫术中出血量（225．7±125．6）ml，血B—HCG下降至正常时间（36．0±9．9）天，术后月经恢复时间（49．8±7．7）天。两组对比差异有统计学意义（P〈0．05）。结论子宫动脉灌注化疗加栓塞术联合B超监测下清宫术治疗剖宫产瘢痕妊娠住院天数短，清宫术中出血少、创伤小、恢复快，可保留生育功能，是治疗CSP的最佳方案。

The efficacy of uterine artery chemoembolization for Cesarean scar pregnancy

Objective To explore the efficacy and safety of uterine artery chemoembolization in the treatment of Cesarean scar pregnancy. Methods 42 women with Cesarean scar pregnancy were randomly divided into group A or B. Group A received uterine artery chemoembolization 3 days before ultrasound- guided dilatation and curettage. Group B received methotrexate and mifepristone and then ultrasound- guided dilatation and curettage as 13 -HCG level declined to less than 200IU/L. Length of hospital stays, intraoperative blood loss, 13 -HCG, and menstrual recovery were observed in both groups. Results In group A, length of hospital stay was （11.2 ± 1.7）days, intraoperative blood loss was （35.2 ± 18.4）ml, time to reduction of 13 -HCG to normal level was （21.2 ± 3.5）days, and time to menstrual recovery was （30.0 ± 4.0）days; while in group B, length of hospital stay was （20.6 ± 5.6）days, intraoperative blood loss was （225.7 ± 125.6）ml, time to reduction of 13 -HCG to normal level was （36.0 ± 9.9）days, and time to menstrual recovery was （49.8 ± 7.7） days, with significant statistical differences （P〈0.05）. Conclusions Uterine artery chemoembolization combined with uhrasound-guided dilatation and curettage can significantly shorten length of hospital stay and reduce intraoperative hemorrhage due to curettage, and is less invasive. Patients have rapid recovery and can preserve reproductive function.. This therapy is the best approach for Cesarean scar pregnancy.