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目的探索子宫动脉栓塞术对剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)清宫效果的影响及安全性。方法回顾性分析2012年3月至2015年10月廊坊市人民医院收治的80例CSP患者的病历资料,按治疗方法不同分为观察组与对照组。观察组采用子宫动脉栓塞术(uterine arterial embolization,UAE)联合宫腔镜下清宫术治疗,对照组采用局部药物治疗后行宫腔镜下清宫术,各40例,比较两组患者清宫过程中的出血量、清宫术时间、不良反应、并发症发生情况、住院时间、血清β-人绒毛膜促性腺激素(beta human chorionic gonadotropin,β-HCG)变化情况及其恢复正常时间,清宫术后随访2月的治疗结局。结果观察组清宫过程中的出血量少于对照组,清宫术时间与住院时间显著短于对照组(P<0.05);观察组β-HCG恢复正常时间少于对照组,差异有统计学意义(P<0.05);观察组治疗成功率(92.5%)显著高于对照组(60.0%);观察组术后4例出现不同程度腹部或臀部疼痛、发热,未发生严重并发症,对照组清宫过程中7例发生大量阴道出血(>1 500 m L),6例患者清宫不全改行病灶切除术。结论 UAE应用于CSP清宫可显著提高临床疗效,改善手术结局,减少出血风险,且不良反应轻微,并发症少,具有良好的安全性。
Objective To explore the effect and safety of uterine arterial embolization on the effect of Cesarean scar pregnancy (CSP) on the curettage. Methods The clinical data of 80 CSP patients treated in Langfang People’s Hospital from March 2012 to October 2015 were retrospectively analyzed. According to the different treatment methods, the patients were divided into observation group and control group. The observation group was treated with uterine arterial embolization (UAE) combined with hysteroscopic curettage, and the control group was treated with hysteroscopic hysteroscopic curettage in 40 cases. The bleeding in the two groups was compared The time, adverse reactions, the incidence of complications, length of hospital stay, serum beta-human chorionic gonadotropin (β-HCG) levels and their recovery time were analyzed. The patients were followed up for 2 months The treatment outcome. Results The amount of bleeding during the observation group was less than that of the control group, and the time of curettage and hospitalization was significantly shorter than that of the control group (P <0.05). The recovery time of β-HCG in the observation group was less than that of the control group P <0.05). The success rate of the treatment group (92.5%) was significantly higher than that of the control group (60.0%). In the observation group, there were 4 cases of pain in the abdomen or buttocks, fever and no serious complications. In 7 cases, a large number of vaginal bleeding occurred (> 1500 m L), and 6 patients underwent radical resection of the esophagus with incomplete curettage. Conclusions The application of UAE to CSP Qinggong can significantly improve the clinical curative effect, improve the operation outcome, reduce the risk of bleeding, and have mild side effects, fewer complications and good safety.