子宫动脉灌注栓塞术联合清宫术治疗剖宫产术后子宫瘢痕部位妊娠
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摘要
目的探讨子宫动脉栓塞术联合清宫术治疗剖宫产术后瘢痕部位妊娠(CSP)的临床价值。方法选取我院妇产科2017年1月至2018年6月确诊为CSP患者50例,随机分为两组。观察组25例行选择性双侧子宫动脉造影,灌注化疗药物甲氨蝶呤(MTX),明胶海绵颗粒栓塞后联合超声引导下清宫术进行治疗;对照组25例采用MTX、米非司酮片联合超声引导下清宫术配合宫腔球囊压迫法进行治疗,观察效果及预后。结果观察组手术时间、术中出血量、术后出血量、住院天数均明显小于对照组,差异有统计学意义(均P<0.05)。观察组与对照组在血绒毛膜促性腺激素降至正常的时间、月经恢复时间比较,差异无统计学意义(均P>0.05)。其中对照组有2例患者清宫时因瘢痕处肌层菲薄,瘢痕处破裂,行开腹手术病灶切除术+子宫下段修补术,术中、术后均无大出血。结论子宫动脉灌注栓塞术联合清宫术治疗CSP疗效显著,安全可靠,可减少清宫术中及术后出血量,并可降低人工流产大出血及子宫切除的风险。
Objective To explore the clinical value of uterine arterial embolization combined with curettage in treatingcesarean scar pregnancy( CSP). Methods A total of 50 patients diagnosed with pregnancy at the site of uterine scar after cesarean section were selected from the department of obstetrics and gynecology of our hospital from January 2017 to June 2018. They were randomly divided into 2 groups:uterine artery embolization group and methotrexate group. 25 cases in observation group were treated by selective bilateral uterine arteriography,infusion of methotrexate( MTX),embolization with gelatin sponge particles and ultrasound-guided uterine curettage. 25 patients in the control group were treated with MTX and mifepristone tablets combined with ultrasound-guided artificial abortion and intrauterine balloon compression.The effect and prognosis were observed. Results The operation time, intraoperative blood loss,postoperative blood loss and length of hospital stay in the observation group were significantly lower than the control group( all P<0.05). There were no statistically significant difference in the time of HCG reduction to normal and the time of menstrual recovery between the two groups( all P > 0. 05). In the control group,2 cases underwent open laparotomy for scar rupture,there was no major bleeding during and after the operation.Conclusion Uterine arterrial infusion and embolization is a reliable method for treatment of CSP,it can prevent the uncontrollable bleeding,and also can reduce that risk of hemorrhage and uterus resection.
Objective To explore the clinical value of uterine arterial embolization combined with curettage in treatingcesarean scar pregnancy( CSP). Methods A total of 50 patients diagnosed with pregnancy at the site of uterine scar after cesarean section were selected from the department of obstetrics and gynecology of our hospital from January 2017 to June 2018. They were randomly divided into 2 groups:uterine artery embolization group and methotrexate group. 25 cases in observation group were treated by selective bilateral uterine arteriography,infusion of methotrexate( MTX),embolization with gelatin sponge particles and ultrasound-guided uterine curettage. 25 patients in the control group were treated with MTX and mifepristone tablets combined with ultrasound-guided artificial abortion and intrauterine balloon compression.The effect and prognosis were observed. Results The operation time, intraoperative blood loss,postoperative blood loss and length of hospital stay in the observation group were significantly lower than the control group( all P<0.05). There were no statistically significant difference in the time of HCG reduction to normal and the time of menstrual recovery between the two groups( all P > 0. 05). In the control group,2 cases underwent open laparotomy for scar rupture,there was no major bleeding during and after the operation.Conclusion Uterine arterrial infusion and embolization is a reliable method for treatment of CSP,it can prevent the uncontrollable bleeding,and also can reduce that risk of hemorrhage and uterus resection.
引文
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[7]郭红玲,徐凤娟,颜士兰,等.子宫动脉栓塞和MTX灌注化疗术在剖宫产术后子宫瘢痕妊娠的应用[J].中国妇产科临床杂志,2012,13(5):368-369.
[8] Lee GS,Hut SY,Kown I,et a1.Diagnosis of early intramural ectopic pregnancy[J].J Clin Ultrasound,2005,33(7):190-192.
[9]周应芳,杨慧霞.重视剖宫产瘢痕妊娠的预防和处置[J].中华妇产科杂志,2014,49(1):3.
[10] Reihaneh P,Leila B,Mahboobeh S. Successful local and systemic medical treatment of cesarean scar pregnancy and a subsequent term pregnancy after treatment:a case series[J].Iran J Reprod Med,2015,13(7):445-450.
[11]汪菁,朱颐,申震等.磁共振成像与阴道彩超多普勒超声诊断剖宫产瘢痕妊娠的临床比较[J].中国临床保健杂志,2015.18(4):356-358.
[12] Huang Y,Li YF,Xi RK,et al. An application of uterine artery chemoembolization in treating cesarean scar pregnancy[J]. Int J Clin Exp Med,2015,8(2):2570-2577.
[13]徐文建,倪才方,谭笑梅.输卵管妊娠灌注栓塞适应证探讨[J].介入放射学杂志,2007,16(9):17-20.
[2] Osbron DA,Willians TR,Craig BM.Cesarean scar pregnancy:sono-graphic and magnetic resonance imaging findings,complications,and treatment[J].J Ultrasound Med,2012,31(9):1449-1456.
[3]陈林霞.剖宫产术后子宫瘢痕妊娠诊断与治疗[J].中外医疗,2013,32(5):32-33.
[4] Ash A,Smith A,Maxwell D. CaesareanⅫpregnancy[J].BJOG,2007,13(4):253-263.
[5] Vial Y,Petignat P,Hohlfeld P.Pregnancy in a cesarean sear[J].Uhrasound Obstet Gynecol,2000,16(6):592-593.
[6]张国福,王添平,守欣,等.子宫动脉栓塞在剖宫产切口瘢痕妊娠中的应用研究[J].介入放射学杂志,2010,19(12):936-939.
[7]郭红玲,徐凤娟,颜士兰,等.子宫动脉栓塞和MTX灌注化疗术在剖宫产术后子宫瘢痕妊娠的应用[J].中国妇产科临床杂志,2012,13(5):368-369.
[8] Lee GS,Hut SY,Kown I,et a1.Diagnosis of early intramural ectopic pregnancy[J].J Clin Ultrasound,2005,33(7):190-192.
[9]周应芳,杨慧霞.重视剖宫产瘢痕妊娠的预防和处置[J].中华妇产科杂志,2014,49(1):3.
[10] Reihaneh P,Leila B,Mahboobeh S. Successful local and systemic medical treatment of cesarean scar pregnancy and a subsequent term pregnancy after treatment:a case series[J].Iran J Reprod Med,2015,13(7):445-450.
[11]汪菁,朱颐,申震等.磁共振成像与阴道彩超多普勒超声诊断剖宫产瘢痕妊娠的临床比较[J].中国临床保健杂志,2015.18(4):356-358.
[12] Huang Y,Li YF,Xi RK,et al. An application of uterine artery chemoembolization in treating cesarean scar pregnancy[J]. Int J Clin Exp Med,2015,8(2):2570-2577.
[13]徐文建,倪才方,谭笑梅.输卵管妊娠灌注栓塞适应证探讨[J].介入放射学杂志,2007,16(9):17-20.