子宫动脉栓塞术对剖宫产术后子宫瘢痕妊娠患者临床疗效及生育功能的影响  

Clinical effect of uterine artery embolization and the impact on reproductive function of patients with cesarean scar pregnancy

作　　者：李洪滨 程勇华 李晓辉 章靖一[2] LI Hong-Bin;CHENG Yong-Hua;LI Xiao-Hui(Zhucheng Hospital of Traditional Chinese Medicine,Zhucheng,Shandong 262200,Chin)

机构地区：[1]诸城中医医院,山东诸城262200 [2]江阴市人民医院,江苏江阴214400

出　　处：《中国妇幼保健》2018年第15期3488-3490,共3页Maternal and Child Health Care of China

摘　　要：目的探讨剖宫产术后子宫瘢痕妊娠患者应用子宫动脉栓塞术介入治疗的临床疗效,并对生育功能的影响进行分析,为临床提供参考。方法选择2014年1月-2016年4月诸城中医医院收治的80例剖宫产术后子宫瘢痕妊娠患者为研究对象,随机分为观察组与对照组,每组各40例。对照组予以肌注MTX联合米非司酮治疗后清宫,观察组在对照组治疗基础上联合子宫动脉栓塞术介入治疗后清宫。比较两组的临床疗效、生育功能及不良反应等情况。结果观察组经过治疗后的有效率(90.0%)与对照组(80.0%)比较,差异无统计学意义(χ~2=1.570,P=0.210)。观察组在术后的阴道流血时间、人绒毛膜促性腺激素(β-h CG)恢复正常水平的时间及月经恢复时间优于对照组,两组比较,差异有统计学意义(t=7.075,P=0.000;t=9.642,P=0.000;t=4.743,P=0.000)。两组有生育要求的患者经6个月的随访后,观察组的输卵管通畅率(87.5%)与对照组(67.5%)比较,差异具有统计学意义(χ~2=4.590,P=0.032)。观察组术后的不良反应发生率与对照组比较,差异无统计学意义(χ~2=0.000,P=1.000)。结论剖宫产术后子宫瘢痕妊娠患者采用米非司酮、MTX,子宫动脉栓塞术介入三联治疗的临床疗效较好,可有效且快速的恢复患者生育功能,不良反应发生率较低,可作为临床上子宫瘢痕妊娠首选的保守治疗方案。Objective To explore the clinical effect of uterine artery embolization in treatment of patients with cesarean scar pregnancy（ CSP）,analyze the effect on reproductive function,provide a reference for clinical treatment.Methods From January 2014 to April 2016,80 patients with CSP treated in Zhucheng Hospital of Traditional Chinese Medicine were selected and randomly divided into observation group and control group,40 patients in each group.The patients in control group were treated by complete curettage of uterine cavity after intramuscular injection of methotrexate combined with mifepristone.The patients in observation group were treated by complete curettage of uterine cavity after intramuscular injection of methotrexate combined with mifepristone and uterine artery embolization.The clinical effects,reproductive function,and adverse reactions in the two groups were observed.Results The effective rates after treatment in observation group and control group were 90.0% and 80.0%,respectively,there was no statistically significant difference between the two groups（ χ~2= 1.570,P= 0.210）.Postoperative vaginal bleeding time,the time of serum β-human chorionic gonadotropin（ β-h CG） return to normal level,and recovery time of menstruation in observation group were statistically significantly better than those in control group（ t = 7.075,P = 0.000; t= 9.642,P = 0.000; t = 4.743,P = 0.000）.After six months of follow-up,the tubal patency rates among the patients with birth requirement in observation group and control group were 87.5% and 67.5%,respectively,there was statistically significant difference between the two groups（ χ~2= 4.590,P = 0.032）.There was no statistically significant difference in the incidence rate of postoperative adverse reactions between the two groups（ χ~2= 0.000,P = 1.000）.Conclusion The clinical effect of mifepristone,methotrexate,and uterine artery embolization is good in treatment of patients with CSP,the method can effectively and rapidly restore reproductive functio

关 键 词：子宫动脉栓塞术 剖宫产术后子宫瘢痕妊娠 临床疗效 生育功能 

分 类 号：R719[医药卫生—妇产科学]