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目的:探讨子宫动脉化疗栓塞术治疗胎盘植入的临床疗效及预后。方法:以胎盘植入患者61例为研究对象,按治疗方式不同分为保守治疗组31例和化疗栓塞组30例。保守治疗组仅单纯口服米非司酮治疗,而化疗栓塞组采用子宫动脉化疗栓塞术进行治疗。比较两组患者的临床疗效、手术时间、出血量、输血量、住院时间、胎盘排出和月经复潮时间,术后并发症的发生情况,并随访术后1年患者的月经情况和妊娠情况。结果:经子宫动脉化疗栓塞术后29例成功止血,有1例未能止血而行子宫切除术。栓塞术后未出现器官局部缺血坏死、神经损伤等严重并发症,发热、下腹痛为常见并发症。而保守治疗组的31例患者中,因治疗失败导致切除子宫的7例,仅24例有效保留子宫,成功率仅77.4%,严重影响患者以后的生育能力。6例发生宫腔感染,4例发生宫腔粘连。子宫动脉化疗栓塞组β-HCG恢复正常时间、输血量、胎盘完全清除时间、月经异常的发生情况均优于保守治疗组,差异有统计学意义(P<0.05)。对子宫动脉化疗栓塞术组患者进行为期1年的随访,14例患者在术后1个月后有胎盘组织自阴道排出,有11例患者2个月后发现胎盘残留,予以清宫术,除3例失访病例,其余患者在随访时间内恢复正常月经,并有2例再次妊娠者。结论:采用子宫动脉化疗栓塞术治疗胎盘植入,其术前准备时间和手术时间均短,出血控制迅速且并发症少,有助于保留患者的子宫,提高患者的生活质量。
Objective: To investigate the clinical efficacy and prognosis of uterine artery chemoembolization in the treatment of placenta accreta. Methods: Totally 61 patients with placenta accreta were divided into two groups: conservative treatment group (31 cases) and chemoembolization group (30 cases). Conservative treatment group only simple oral mifepristone treatment, and chemotherapy embolization group uterine artery chemoembolization for treatment. The clinical efficacy, operation time, blood loss, blood transfusion, hospital stay, placenta discharge and menstrual cycle, postoperative complications and the menstrual status and pregnancy status were compared between the two groups. Results: Twenty-nine patients underwent transcatheter uterine arterial chemoembolization successfully hemostasis. One patient failed to stop the bleeding and underwent hysterectomy. After embolization did not appear organ ischemia and necrosis, nerve injury and other serious complications, fever, lower abdominal pain as a common complication. Among the 31 patients in the conservative treatment group, only 7 of the 31 patients with failed uterus resulted in the removal of the uterus, and only 24 of them retained the uterus effectively, with a success rate of only 77.4%, which seriously affected their fertility. Uterine infection occurred in 6 cases and intrauterine adhesions occurred in 4 cases. Uterine artery chemoembolization group β-HCG recovery time, blood transfusion, complete removal of placenta, menstrual abnormalities were better than the conservative treatment group, the difference was statistically significant (P <0.05). One year of follow-up was performed on patients with uterine arterial chemoembolization, 14 patients had placental tissue excreted from the vagina one month after surgery, and 11 patients had residual placenta found after 2 months. Cases of lost cases, the rest of the patients returned to normal menstruation at follow-up time, and 2 cases of second pregnancy. Conclusion: The treatment of placenta accreta with uterine arterial chemoembolization has short preoperative preparation time and operation time, rapid control of bleeding and fewer complications, which helps to preserve the uterus and improve the quality of life of patients.