子宫动脉灌注化疗栓塞联合清宫术治疗剖宫产术后瘢痕妊娠的临床研究

摘要

目的：探讨子宫动脉灌注化疗栓塞联合清宫术在治疗剖宫产术后瘢痕妊娠中的临床价值。方法：回顾性分析2009年1月-2014年1月成都市第二人民医院收治的41例CSP患者的临床资料，随机分为介入组和对照组；介入组(22例)采用子宫动脉灌注化疗栓塞联合清宫术进行治疗，对照组(19例)进行药物联合清宫术治疗。结果：介入组均在术后72 h内进行了清宫术，清宫术中出血量为(45.3±8.4)ml，住院(16.4±6.8)d，血β-hCG恢复正常的时间为(17.7±8.6)d，住院费用(15039±1435)元。对照组13例顺利进行了清宫术，术中出血量为(290.3±19.4)ml，住院(26.8±13.2)d，血β-hCG恢复正常的时间为(28.6±7.2)d，住院费用为(5607±786)元；差异均有统计学意义(P<0.05)；对照组中6例清宫术中大出血，其中2例清宫术中出血大于500 ml，行紧急子宫动脉造影栓塞术，3例行子宫动脉造影栓塞术后，行腹腔镜下病灶切除及子宫修补术；1例出血大于1000 ml，行经腹全子宫切除术。结论：子宫动脉灌注化疗栓塞联合清宫术是治疗剖宫产术后瘢痕妊娠的一种安全有效的方法，具有手术出血少、住院天数少、创伤小且能有效保留患者的生育能力，值得临床推广。%Objective:To assess the clinical value of uterine arterial chemoembolization(UACE) combined curettage in treating uterine scar pregnancy after cesarean section.Method:A total of 41 cases with cesarean scar pregnancy,admitted to Chengdu second people’s hospital during the period from Jan.2009 to Jan 2014,were divided into two groups: embolization group(n=22) and control group(n=19).The embolization group were given UACE combined curettage,and the control group were given drug intervention combined currtage.Result:For embolization group,all patients were accepted curettage within 72 hours ofter UACE, the mean blood loss was (45.3±8.4)ml,the mean hospitalization days was (16.4±6.8)days,and the time for β-hCG levels falling to normal was (17.7±8.6)days, and the mean hospital costs were(15 039±1435)yuan.While for control group,only 13 cases were successfully taken curettage, the mean blood loss in curettage was (290.3±19.4)ml,the mean hospitalization days was (26.8±13.2)days,and the time for β-HCG levels falling to normal was (28.6±7.2)days,and the mean hospital costs were (5607±786)yuan. The difference was statistically significant for two groups (P<0.05).2 cases of blood loss more than 500 ml,were accepted emergency uterine artery embolization,3 patients were accepted laparoscopic excision and uterine repair after uterine artery embolization,and one case of blood loss was more than 1000 ml in curettage,were taken abdominal hysterectomy.Conclusion:Uterine arterial chemoembolization combined curettage(UACE) is a safe and effective treatment for cesarean section scar pregnancy,with less blood loss,fewer hospitalization days,less invasion and can effectively preserve the fertility of patients.which is worth being used in clinical practice.