预防性子宫动脉化疗栓塞术序贯超声导引下清宫术治疗瘢痕妊娠的临床观察

摘要

目的 评估预防性子宫动脉化疗栓塞术(UACE)序贯超声导引下清宫术治疗剖宫产后瘢痕妊娠(CSP)的临床应用价值.方法 回顾性分析231例行UACE序贯超声导引下清宫术治疗的CSP患者临床资料及随访资料.结果 231例患者经UACE序贯超声导引下清宫术治疗均成功终止妊娠,所有患者均未出现失血性休克或死亡事件,清宫术出血量中位值10 ml;清宫术后实验室检查示RBC、HGB、 HCT中位值(分别为3.53x1012/L,105 g/L,32％)对比 UACE术前(分别为4.04×1012/L,121 g/L,36％)存在轻度下降,差异具有统计学意义P＜0.001),β-HCG(人绒毛膜促性腺激素)中位值清宫术后(1 723.5 U/ml)对比UACE术前(29 069.0 U/ml)下降明显,差异具有显著统计学意义(P＜0.001).按照孕龄将患者分为A组(孕龄≤56 d)和B组(57 d≤孕龄d)进行分层分析,UACE术后清宫术出血量及RBC、HGB、HCT下降程度无显著差异.结论 CSP清宫术前预防性行UACE可以有效减少清宫术中大出血发生,UACE序贯超声导引下清宫术治疗CSP疗效安全可靠,可作为治疗CSP的常规治疗策略.%Objective To evaluate the clinical application of prophylactic uterine artery chemoembolization (UACE) together with sequential ultrasound-guided curettage of uterine cavity for the treatment of cesarean scar pregnancy (CSP). Methods The clinical data and follow-up results of 231 CSP patients who were treated with UACE together with sequential ultrasound-guided curettage of uterine cavity were retrospectively analyzed. Results After UACE together with sequential ultrasound-guided curettage of uterine cavity, successful termination of pregnancy was achieved in all 231 patients, neither hemorrhagic shock nor death occurred. The median amount of blood loss during curettage of uterine cavity was 10 ml. After curettage of uterine cavity, the median values of RBC, HGB and HCT were 3.53×1012/L, 105 g/L and 32％ respectively, the preoperative median values of which were 4.04×1012/L, 121 g/L and 36％ respectively, indicating there were a slight reduction in RBC, HGB and HCT after UACE, the differences were statistically significant (P＜0.001). The median values of β-HCG measured before UACE and after curettage of uterine cavity were29 069.0 U/ml and 1723.5 U/ml respectively, the difference was statistically significant (P＜0.001). According to the gestational age, the patients were divided into group A (gestational age ≤56 days) and group B (gestational age 57-81 days). Further stratified analysis showed that no statistically significant differences in blood loss during curettage of uterine cavity and in reduction degree of RBC, HGB and HCT after UACE existed between group A and group B. Conclusion Prophylactic UACE before CSP can effectively reduce the occurrence of massive bleeding during uterine curettage. For the treatment of CSP, UACE together with sequential ultrasound-guided curettage of uterine cavity is safe and reliable. Therefore, this therapy can be used as a routine treatment strategy for CSP.