宫腔镜联合子宫动脉栓塞治疗剖宫产瘢痕妊娠的疗效及安全性分析

目的分析宫腔镜联合子宫动脉栓塞(UAE)治疗剖宫产瘢痕妊娠(CSP)的疗效及安全性。方法选择该院收治的CSP患者85例,将其随机分为观察组43例和对照组42例,观察组采取UAE、甲氨蝶呤(MTX)子宫动脉灌注化疗以及宫腔镜手术治疗,对照组采取MTX静脉滴注联合超声监视下清宫术治疗,比较两组患者手术相关情况、术后疼痛程度、并发症以及患者月经复潮情况。结果观察组患者术中出血量、术后住院时间、阴道出血量以及阴道出血持续时间均明显低于对照组(P<0.05)。术后2、7、14和21 d观察组患者血人绒毛膜促性腺激素(β-HCG)水平明显低于对照组(P<0.05)。观察组患者术后疼痛程度明显轻于对照组(P<0.05)。两组患者中转开腹、二次清宫、大出血以及子宫切除率比较,差异均无统计学意义(P>0.05),但观察组并发症总发生率明显低于对照组(P<0.05)。观察组患者月经复潮曲线明显优于对照组(P<0.05)。结论 UAE与MTX动脉灌注联合宫腔镜手术治疗CSP疗效确切,手术并发症少,患者术后康复快,是一种值得推荐的手术方式。

Analysis of the efficacy and safety of hysteroscopy combined with uterine artery embolization in treatment of cesarean scar pregnancy

Abstract: Objective To explore the efficacy and safety of hysteroscopy combined with uterine artery embolization (UAE) in treatment of cesarean scar pregnancy. Methods 85 cases of caesarean scar pregnancy were randomly divided into 43 cases in the observation group and 42 cases in the control group. The observation group was treated with UAE, methotrexate (MTX) uterine artery infusion chemotherapy and hysteroscopy, and the control group was treated with MTX intravenous drip combined with ultrasonic monitoring, and the operation of two groups was compared. Related conditions, postoperative pain, complications and menstrual recovery. Results The intraoperative blood loss, postoperative hospital stay, vaginal bleeding and duration of vaginal bleeding in the observation group were significantly lower than those in the control group (P < 0.05). At day 2 after operative, at day 7 after operative, at day 14 after operative and at 21 day after operative in the observation group were significantly lower than those in the control group (P < 0.05). The pain level of the observation group was significantly less than that of the control group (P < 0.05). There was no significant difference in the rate of transabdominal, two palace, bleeding and hysterectomy in the two groups (P > 0.05), but the total incidence of complications in the observation group was significantly lower than that of the control group (P < 0.05). The menstrual recovery curve in the observation group was significantly better than that in the control group (P < 0.05). Conclusion UAE and methotrexate artery care combined with hysteroscopy in the treatment of cesarean scar pregnancy is effective, less operative complications and quick recovery after operation. It is a recommendable surgical method.