子宫动脉化疗栓塞联合宫腔镜终止剖宫产瘢痕妊娠的可行性

目的观察子宫动脉栓塞术（UAE）联合宫腔镜治疗剖宫产切口瘢痕妊娠（CSP）的疗效,探索CSP更为安全有效的治疗手段。方法回顾性分析2006年10月至2013年8月因CSP需中止妊娠的63例患者的临床资料,按治疗方法分为研究组（36例）及对照组（27例）,研究组采用UAE＋甲氨蝶呤（MTX）子宫动脉灌注化疗＋宫腔镜手术治疗,对照组采用MTX静脉滴注并超声监视下清宫术治疗,比较两组患者的结局、并发症、月经恢复情况等。结果（1）研究组首次清宫出血量、术后阴道出血量、出血持续时间及住院时间少于对照组（P〈0.01或P〈0.05）,住院费用高于对照组（P〈0.01）。（2）两组二次清宫率、大出血发生率、中转开腹手术率和子宫切除率差异均无统计学意义（P均〉0.05）。（3）清宫后两组血β-HCG均显著降低（F=213.654,P〈0.01）,且研究组降低程度甚于对照组（F=15.361,P〈0.01）。（4）研究组月经复潮曲线高于对照组（χ^2=4.247,P〈0.05）,两组平均复潮时间分别为37.917（95%CI：35.277～40.556）d和43.962（95%CI：38.935～48.988）d。结论采用UAE预处理联合宫腔镜手术终止CSP具有疗效可靠、安全性高、术后康复快等优点。

Feasibility of uterine arterial embolization and chemotherapy combined with hyteroscopic surgery for terminating caesarean scar pregnancy

Objective To observe the therapeutic effect of combining use of uterine arterial embolization（ UAE） plus chemotherapy and hyteroscopic surgery for terminating caesarean scar pregnancy（ CSP） and explore the safe and effective treatment method for CSP. Methods The clinical data of 63 CSP patients needed terminating pregnancy between October2006 and August 2013 were retrospectively analyzed. The patients were divided into two groups according to therapy method： research group（ 36 cases） and control group（ 27 cases）. The combining use of UAE,uterine arterial perfusion chemotherapy with methotrexate（ MTX） and hyteroscopic surgery was administered in research group. The combining use of MTX intravenous drip and curettage with ultrasonic monitoring was adopted in control group. The therapeutic outcome,complications and the condition of menstruation turn over were compared in two groups. Results（ 1） The bleeding amount when the first curettage,the vaginal bleeding amount after surgery,the duration of bleeding and hospital stays in research group were all less than those in control group（ P〈0. 01 or P〈0. 05）,while the hospital cost in research group was higher than that in control group（ P〈0. 01）.（ 2） There were no statistical differences in the incidence of the two curettages,the incidence of massive bleeding,the rates of converting to laparotomy and hysterectomy between two groups（ all P〉0. 05）.（ 3） The β-human chorionic gonadotropin（ β-HCG） levels after curettage in two groups were all decreased significantly（ F = 213. 654,P〈0. 01）,and the decreased degree in research group was more obvious than that in control group（ F = 15. 361,P〈0. 01）.（ 4） The curve of menstruation turn over in research group was higher than that in control group（ χ^2= 4. 247,P〈0. 05）,and the average time of menstruation turn over in research group and control group were 37. 917（ 95% CI：35.277-40.556） d and 43.962（ 95% CI：38.935-48.988） d,respectively. Co