选择性子宫动脉栓塞术联合宫腔镜手术治疗外生型剖宫产术后子宫瘢痕妊娠的临床分析

摘要

Objective To explore the clinical efficacy of selective uterine artery embolization (UAE) combined with hysteroscopic operation in treatment of exogenous type cesarean section uterine scar pregnancy (CSP).Methods A total of 130 patients with CSP were randomly divided into two groups,patients in observation group were applied with UAE combined hysteroscopic operation,and patients in control group were administrated with muscular injection of methotrexate combined with hysteroscopic debridement.The time for inversion of blood β-human chorionic gonadotropin (β-HCG),the duration for disappearance of lesions,the time for recovery of menstrual bleeding,the duration for hospital stay and successful rate of treatment,and the occurrence of postoperative adverse reactions were recorded and compared between these two groups.Results The inversion time for blood β-HCG,the disappearance of lesions,time for menstrual recovery and duration of hospital stay in patients of observation group were shorter than those of patients in control group (P＜0.05).The amount of intraoperative blood loss (33.6±5.8 ml) in patients of observation group was less than that(71.3±6.1 ml)of patients in control group (P＜0.05).The successful rate (96.9％) of patients in observation group was obviously higher than that (84.6％) of patients in control group (P＜0.05).The incidence of postoperative adverse reactions in observation group was 3.1％,and it was obviously less than that (16.9％) of control group (P＜0.05).Conclusion The curative effect of UAE combined with hysteroscopic operation in treatment of exogenous type CSP is exact with advantages of small trauma,rapid recovery,high safety and reliability,hence it has certain advantages and feasibility.%目的 探究选择性子宫动脉栓塞术(UAE)联合宫腔镜手术治疗外生型剖宫产术后子宫瘢痕妊娠(CSP)的临床效果.方法 将130例外生型CSP患者随机分为两组.对照组予以甲氨喋呤肌肉注射加宫腔镜下清宫术治疗,观察组予以UAE联合宫腔镜手术治疗.观察对比两组血β人绒毛膜促性腺激素(β-HCG)转阴时间、病灶消失时间、月经恢复时间、住院时间、术中出血量及治疗成功率,并记录两组术后不良反应发生情况.结果 观察组血β-HCG转阴时间、病灶消失时间、月经恢复时间、住院时间均短于对照组(P＜0.05),且观察组术中出血量(33.6±5.8 ml)少于对照组(71.3±6.1 ml)(P＜0.05).观察组治疗成功率(96.9％)明显高于对照组(84.6％)(P＜0.05).观察组术后不良反应发生率(3.1％)明显低于对照组(16.9％)(P＜0.05).结论 UAE联合宫腔镜手术治疗外生型CSP的疗效确切,且损伤小、恢复快、安全性好,具有一定优势和可行性.