子宫动脉栓塞术在早期、中期剖宫产切口部妊娠中疗效的对比分析  

Comparative Analysis of Uterine Artery Embolization in First and Second Trimester Cesarean Scar Pregnancy

作　　者：王海波[1] 李刚 陈清亮 梁昊 张伟[2] WANG Haibo;LI Gang;CHEN Qingliang(Department of Radiology,Seventh People’s Hospital of Zhengzhou,Zhengzhou,Henan Province 450016,P.R.China)

机构地区：[1]郑州市第七人民医院放射科,450016 [2]郑州市第一人民医院介入科,450004 [3]河南省直第三人民医院放射科,郑州450006

出　　处：《临床放射学杂志》2022年第8期1545-1549,共5页Journal of Clinical Radiology

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20210712)。

摘　　要：目的探讨子宫动脉栓塞术(UAE)在中期剖宫产切口部妊娠(CSP)治疗中的价值。方法搜集郑州市第一人民医院、河南省直第三人民医院、郑州市第七人民医院2016年1月1日至2021年6月30日间CSP出院患者的临床资料,经筛选后共有134例早期CSP、16例中期CSP被纳入本研究,并分为早期CSP组和中期CSP组。比较两组间以下指标:基线检验指标:年龄、孕周、剖宫产次数、末次剖宫产时间、流产次数、有无阴道出血及腹痛症状、血清β-人绒毛膜促性腺激素(β-HCG)水平、有无胎心活动及UAE至清宫手术时间。UAE后的临床结局:UAE后24 h血清β-HCG下降程度、有无清宫术中大出血及输注浓缩红细胞、有无子宫切除及妊娠组织残留、血清β-HCG转阴时间及月经恢复时间。结果两组在年龄、剖宫产次数、流产次数、腹痛症状、末次剖宫产时间、血清β-HCG水平、有无胎心搏动及UAE至清宫手术时间方面差异无统计学意义(P均>0.05);在孕周及阴道出血症状方面差异有统计学意义(P均<0.05)。两组患者UAE成功率为100%。中期CSP组5例、早期CSP组14例患者血管造影发现侧支供血血管,侧支血管来源主要为膀胱动脉和阴部内动脉,术中所有侧支血管均被栓塞。两组患者UAE后0.5~8天均接受清宫手术,无子宫切除及妊娠组织残留事件发生。两组在UAE后24 h血清β-HCG下降程度、血清β-HCG转阴时间及月经恢复时间方面差异无统计学意义(P均>0.05);清宫术中大出血、输注浓缩红细胞方面差异有统计学意义(P均<0.05)。结论与早期CSP相比,中期CSP的UAE显示了同样良好的疗效及安全性,可以作为中期CSP治疗中优先考虑的辅助手段。中期CSP患者UAE后的清宫术中大出血及输注浓缩红细胞占比高于早期CSP,需要在术前准备中格外重视。Objective To investigate the value of uterine artery embolization(UAE)in the treatment of second trimester cesarean scar pregnancy(CSP).Methods The clinical data of CSP patients discharged from the First People’s Hospital of Zhengzhou,Henan No.3 Provincial People’s Hospital and the Seventh People’s Hospital of Zhengzhou from January 1,2016 to June 30,2021were collected,a total of 134 first trimester CSP and 16 second trimester CSP were included after screening,and divided into first trimester CSP group and second trimester CSP group respectively.The following indexes were compared between the two groups:Baseline test indexes:age,gestational week,number of cesarean sections,time of last cesarean section,number of abortions,vaginal bleeding and abdominal pain symptoms,serumβ-human chorionic gonadotropin(β-HCG)level,fetal heart activity and the time from UAE to pregnancy tissue clearance.Clinical outcome after UAE:the reduction in serumβ-HCG at 24 hours after UAE,intraoperative haemorrhage,infusion of concentrated red blood cells,hysterectomy and pregnancy tissue residue,the time of conversion of serumβ-HCG to negative and the time for menstrual recovery.Results There were no statistically significant difference between the two groups in age,the number of cesarean sections,the number of abortions,abdominal pain,time of last cesarean section,serumβ-HCG level,fetal heart activity and the time from UAE to pregnancy tissue clearance(all P>0.05),and in gestational weeks and vaginal bleeding,the difference were statistically significant(all P<0.05).The success rate of UAE in two groups was 100%.5 cases in second trimester CSP group and 14 cases in first trimester CSP group were found collateral blood supply vessels on angiography,the main sources of collateral vessels were bladder artery and internal pudendal artery,and all collateral vessels were embolized during the operation.All patients in two groups were performed pregnancy tissue clearance within 0.5-8 days after UAE,and there were no hysterectomy and pre

关 键 词：剖宫产切口部妊娠 子宫动脉 栓塞术 疗效 数字减影血管造影 

分 类 号：R714.22[医药卫生—妇产科学]