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目的观察子宫动脉栓塞术(UAE)联合宫腔镜治疗剖宫产切口瘢痕妊娠(CSP)的疗效,探索CSP更为安全有效的治疗手段。方法回顾性分析2006年10月至2013年8月因CSP需中止妊娠的63例患者的临床资料,按治疗方法分为研究组(36例)及对照组(27例),研究组采用UAE+甲氨蝶呤(MTX)子宫动脉灌注化疗+宫腔镜手术治疗,对照组采用MTX静脉滴注并超声监视下清宫术治疗,比较两组患者的结局、并发症、月经恢复情况等。结果(1)研究组首次清宫出血量、术后阴道出血量、出血持续时间及住院时间少于对照组(P<0.01或P<0.05),住院费用高于对照组(P<0.01)。(2)两组二次清宫率、大出血发生率、中转开腹手术率和子宫切除率差异均无统计学意义(P均>0.05)。(3)清宫后两组血β-HCG均显著降低(F=213.654,P<0.01),且研究组降低程度甚于对照组(F=15.361,P<0.01)。(4)研究组月经复潮曲线高于对照组(χ2=4.247,P<0.05),两组平均复潮时间分别为37.917(95%CI:35.277~40.556)d和43.962(95%CI:38.935~48.988)d。结论采用UAE预处理联合宫腔镜手术终止CSP具有疗效可靠、安全性高、术后康复快等优点。
Objective To observe the effect of uterine arterial embolization (UAE) combined with hysteroscopy in the treatment of cesarean scar pregnancy (CSP) and explore the more safe and effective CSP treatment. Methods The clinical data of 63 patients with pregnancy discontinuation due to CSP from October 2006 to August 2013 were retrospectively analyzed. According to the treatment methods, 36 cases were divided into study group (36 cases) and control group (27 cases). UAE + Methotrexate (MTX) uterine artery infusion chemotherapy and hysteroscopic surgery, the control group using MTX intravenous drip and ultrasound under the curettage curettage, the two groups were compared the outcome, complications, menstruation recovery and so on. Results (1) The amount of blood loss, amount of postoperative vaginal bleeding, duration of bleeding and hospital stay in the study group were less than those in the control group (P <0.01 or P <0.05), and hospitalization costs were higher than those in the control group (P <0.01). (2) There was no significant difference between the two groups in the rate of secondary clearance, the incidence of hemorrhage, the rate of laparotomy in laparotomy, and the rate of hysterectomy (all P> 0.05). (3) The serum levels of β-HCG were significantly decreased in both groups (F = 213.654, P <0.01), and the reduction in the study group was more severe than that in the control group (F = 15.361, P <0.01). (2) The mean tidal rewet times were 37.917 (95% CI: 35.277-40.556) d and 43.962 (95% CI: 38.935, respectively) in the study group (χ2 = 4.247, P < ~ 48.988) d. Conclusion UAE pretreatment combined with hysteroscopic termination of CSP has the advantages of reliable curative effect, high safety and quick postoperative recovery.