两种子宫动脉栓塞方式联合超声监控下D&C治疗CSP的疗效分析  

Analysis of therapeutic effect of two uterine artery embolization modes combined with dilatation and curettage under ultrasonic monitoring in the treatment of cesarean scar pregnancy

作　　者：王建爽 张海静 王雪松 文颖 周子敬 WANG Jian-shuang;ZHANG Hai-jing;WANG Xue-song;WEN Ying;ZHOU Zi-jing(Department of Ultrasound Diagnosis,the Fourth People′s Hospital of Langfang City,Hebei Province,Langfang 065700,China;Department of Obstetrics and Gynecology,the Fourth People′s Hospital of Langfang City,Hebei Province,Langfang 065700,China)

机构地区：[1]河北省廊坊市第四人民医院超声诊断科,河北廊坊065700 [2]河北省廊坊市第四人民医院妇产科,河北廊坊065700

出　　处：《河北医科大学学报》2023年第5期579-583,共5页Journal of Hebei Medical University

摘　　要：目的比较两种子宫动脉栓塞方式联合超声监控下清宫术(dilatation and curettage,D&C)治疗剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的疗效。方法回顾性分析本院CSP患者96例。按照患者意愿分为A组73例和B组23例,A组采用子宫动脉化疗栓塞术(uterine artery chemoembolization,UACE)联合超声监控下D&C治疗,B组采用子宫动脉栓塞(uterine artery embolization,UAE)联合超声监控下D&C治疗。比较2组术后5周血人绒毛膜促性腺激素(β-human chorionic gonadotrophin,β-HCG)转阴及月经复潮比例、住院时间、住院费用、术中出血量及输血比例、二次治疗比例。术后3个月行输卵管造影监测输卵管是否通畅,同时对患者再次妊娠及CSP复发情况进行为期3年的电话随访。结果2组D&C前血β-HCG水平差异有统计学意义(P<0.05)。A组术后5周血β-HCG转阴及月经复潮比例高于B组(P<0.05),术中出血量、术中输血比例、二次治疗比例低于B组(P<0.05)。A组患者术后3个月输卵管通畅率高于B组(P<0.05),2组术后3年异位妊娠、CSP复发、正常妊娠、流产、活产比例比较,差异均无统计学意义(P>0.05)。2组均未发生异位栓塞、大出血、子宫破裂等术后严重并发症。结论与UAE联合超声监测下D&C相比,UACE联合超声监测下D&C可更有效地减少术中出血,提高治疗效果。Objective To compare the therapeutic effect of two uterine artery embolization(UAE)modes combined with dilatation and curettage(D&C)under ultrasonic monitoring in the treatment of cesarean scar pregnancy(CSP).Methods Retrospective analysis was performed on the data of 96 patients with CSP in our hospital.According to the patient′s wishes,all patients were divided into group A(n=73)and group B(n=23).Group A was treated with uterine artery chemoembolization(UACE)combined with ultrasound-guided D&C,while group B was treated with UAE combined with ultrasound-guided D&C.Comparison was made between two groups on the proportion of negative conversion ofβ-HCG and menorrhagia at 5 weeks after surgery,length of hospitalization,hospitalization expenses,intraoperative blood loss,proportion of blood transfusion and proportion of secondary treatment.Salpingography was performed at three months after the operation to monitor the patency of the fallopian tubes,and a three-year telephone follow-up was conducted for the second pregnancy and the recurrence of CSP.Results The level ofβ-HCG before D&C was significantly different between two groups(P<0.05).The proportion of negative conversion ofβ-HCG and menorrhagia at 5 weeks after operation in group A was higher than that in group B(P<0.05),and intraoperative blood loss,and the proportion of intraoperative blood transfusion and secondary treatment were lower than those in group B(P<0.05).The rate of fallopian tube patency in group A was higher than that in group B at three months after operation(P<0.05),and the ratio of ectopic pregnancy,CSP recurrence,normal pregnancy,abortion and live birth at three years after operation in the two groups was not significantly different(P>0.05).No serious postoperative complications such as ectopic embolism,massive hemorrhage and uterine rupture occurred in either group.Conclusion Compared with UAE combined with D&C under ultrasonic monitoring,UACE combined with D&C under ultrasonic monitoring can reduce intraoperative bleeding and improve t

关 键 词：妊娠 异位 子宫动脉化疗栓塞术 超声检查 

分 类 号：R714.22[医药卫生—妇产科学]