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目的:探讨子宫动脉栓塞(UAE)联合甲氨蝶呤(MTX)子宫动脉灌注后吸宫术治疗剖宫产后瘢痕妊娠(CSP)的疗效和安全性。方法:收集48例CSP患者的临床资料,根据治疗方法分为UAE组和MTX组。UAE组23例,采用UAE+MTX子宫动脉灌注+吸宫术治疗;MTX组25例,采用MTX肌内注射+吸宫术治疗,比较分析两组患者的临床资料及临床结局。结果:两组患者的年龄、孕产史、末次剖宫产术距本次妊娠的间隔时间及孕周比较差异无统计学意义(P>0.05);治疗前,两组患者孕囊/妊娠包块的直径及β-人绒毛膜促性腺激素(β-h CG)水平比较差异无统计学意义(P>0.05);UAE组治疗后患者阴道流血超过100 ml/d的例数及吸宫术术中出血量较MTX组明显减少(P<0.05),住院时间较MTX组明显缩短(P<0.05)。β-h CG水平下降较MTX组明显增快(P<0.05),成功率更高,但UAE组不良反应发生率较MTX组明显增多(P<0.05);两组患者均无子宫切除,均痊愈出院。所有患者月经恢复在清宫术后10~60天,平均(30.6±9.2)天。结论:UAE+MTX子宫动脉灌注后吸宫术是治疗CSP的一种有效而安全的方式。
Objective: To investigate the efficacy and safety of uterine arterial embolization (UAE) and methotrexate (MTX) uterine artery infusion after cesarean section in the treatment of post-cesarean scar pregnancy (CSP). Methods: The clinical data of 48 patients with CSP were collected and divided into UAE group and MTX group according to the treatment method. UAE group, 23 cases were treated with UAE + MTX uterine artery infusion and suction palace; 25 cases of MTX group were treated by intramuscular injection of MTX and suction palace, comparing the clinical data and clinical outcomes of the two groups. Results: There was no significant difference between the two groups in terms of age, pregnancy history, the last cesarean section and the gestational age (P> 0.05). Before treatment, gestational sac / pregnancy pack There was no significant difference in the diameter of the block and β-hCG between the UAE group and the UAE group (P> 0.05) The blood loss in operation was significantly lower than that in MTX group (P <0.05), and the hospitalization time was significantly shorter than that in MTX group (P <0.05). (P <0.05), and the success rate was higher. However, the incidence of adverse reactions in UAE group was significantly higher than that in MTX group (P <0.05). No hysterectomy was found in both groups Healed and discharged. All patients with menstruation recovery in the Qing Gong 10 to 60 days, with an average (30.6 ± 9.2) days. Conclusion: UAE + MTX after uterine arterial infusion is an effective and safe treatment for CSP.