剖宫产瘢痕妊娠两种治疗策略比较
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摘要
目的比较子宫动脉灌注化疗栓塞术(UACE)联合宫腔镜和超声导引下囊内注射甲氨蝶呤(MTX)联合宫腔镜治疗剖宫产瘢痕妊娠(CSP)的安全性、疗效及并发症。方法回顾性分析嘉兴市3家医院100例CSP患者病史资料及治疗经过,其中A组50例接受UACE联合宫腔镜清宫术,B组50例接受超声导引下囊内注射MTX联合宫腔镜清宫术,比较治疗效果。结果 A组患者UACE手术顺利,术后2～6 d内宫腔镜治疗后患者未出现大出血转开腹手术;B组患者超声导引下孕囊内注射MTX顺利,术后6～8 d宫腔镜治疗后2例出现大出血转开腹手术。A组宫腔镜术中出血量低于B组(P<0.05),住院时间短于B组(P<0.05)。结论 UACE联合宫腔镜治疗CSP安全性高,疗效确切,并发症发生率低。
Objective To compare the safety, efficacy and complications of uterine artery chemoembolization(UACE) plus hysteroscopic curettage with those of ultrasound-guided intra-gestational sac methotrexate(MTX) injection plus hysteroscopic curettage in treating cesarean scar pregnancy(CSP).Methods The clinical data and treatment process of 100 patients with CSP, who were collected from three hospitals in Jiaxing City of China, were retrospective analyzed. The patients were divided into group A(n=50,receiving UACE plus hysteroscopic curettage) and group B(n =50, receiving ultrasound-guided intra-gestational sac MTX injection plus hysteroscopic curettage), and the curative effects were compared between the two groups. Results In group A, UACE was successfully accomplished in all patients, which was followed by hysteroscopic curettage in 2-6 days, and no patient had massive bleeding that needed to be transferred to open surgery. In group B, successful ultrasound-guided intra-gestational sac MTX injection was achieved in all patients, which was followed by hysteroscopic curettage in 6-8 days, and 2 patients developed massive bleeding and had to be transferred to open surgery. The volume of blood loss during hysteroscopy in group A was significantly lower than that in group B(P <0.05), and the duration of hospitalization in group A was shorter than that in group B(P<0.05). Conclusion For the treatment of CSP,UACE combined with hysteroscopic curettage is highly safe with reliable curative effect and lower incidence of complications.(J Intervent Radiol, 2019, 28: 574-577)
Objective To compare the safety, efficacy and complications of uterine artery chemoembolization(UACE) plus hysteroscopic curettage with those of ultrasound-guided intra-gestational sac methotrexate(MTX) injection plus hysteroscopic curettage in treating cesarean scar pregnancy(CSP).Methods The clinical data and treatment process of 100 patients with CSP, who were collected from three hospitals in Jiaxing City of China, were retrospective analyzed. The patients were divided into group A(n=50,receiving UACE plus hysteroscopic curettage) and group B(n =50, receiving ultrasound-guided intra-gestational sac MTX injection plus hysteroscopic curettage), and the curative effects were compared between the two groups. Results In group A, UACE was successfully accomplished in all patients, which was followed by hysteroscopic curettage in 2-6 days, and no patient had massive bleeding that needed to be transferred to open surgery. In group B, successful ultrasound-guided intra-gestational sac MTX injection was achieved in all patients, which was followed by hysteroscopic curettage in 6-8 days, and 2 patients developed massive bleeding and had to be transferred to open surgery. The volume of blood loss during hysteroscopy in group A was significantly lower than that in group B(P <0.05), and the duration of hospitalization in group A was shorter than that in group B(P<0.05). Conclusion For the treatment of CSP,UACE combined with hysteroscopic curettage is highly safe with reliable curative effect and lower incidence of complications.(J Intervent Radiol, 2019, 28: 574-577)
引文
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[4]Sun YY,Xi XW,Yan Q,et al.Management of typeⅡunruptured cesarean scar pregnancy:comparison of gestational mass excision an d uterine arteryembolization combied with methotrexate[J].Taiwan J Obstet Gynecol,2015,54:489-492.
[5]李奎,颜国辉,邹煜.子宫动脉栓塞与甲氨蝶呤治疗不同MRI分型的剖宫产术后疤痕妊娠的疗效评价[J].中华介入放射学电子杂志,2017,5:128-134.
[6]王文芳,陈秀慧,王德莹,等.宫腔镜联合子宫动脉栓塞术在剖宫产切口瘢痕妊娠中应用的可行性分析[J].实用妇产科杂志,2013,29:840-843.
[7]刘炳光,曹满瑞,张玉霞,等.子宫动脉栓塞与化疗栓塞治疗瘢痕妊娠疗效比较[J].介入放射学杂志,2015,24:588-591.
[8]顾祝新,黄健,赵辉,等.子宫瘢痕妊娠两种疗法的对照研究[J].介入放射学杂志,2015,24:625-628.
[9]张宇慧,周顺科.子宫肌瘤介入治疗近展[J].介入放射学杂志,2013,22:340-345.
[2]Seow KM,Huang LW,Lin YH,et al.Cesarean scar pregnancy:issues in management[J].Ultrasound Obstet Gynecol,2004,23:247-253.
[3]朱志韬,孙志先,祖茂衡,等.子宫动脉栓塞术预防疤痕妊娠清宫大出血的临床价值[J].中华介入放射学电子杂志,2017,5:13-16.
[4]Sun YY,Xi XW,Yan Q,et al.Management of typeⅡunruptured cesarean scar pregnancy:comparison of gestational mass excision an d uterine arteryembolization combied with methotrexate[J].Taiwan J Obstet Gynecol,2015,54:489-492.
[5]李奎,颜国辉,邹煜.子宫动脉栓塞与甲氨蝶呤治疗不同MRI分型的剖宫产术后疤痕妊娠的疗效评价[J].中华介入放射学电子杂志,2017,5:128-134.
[6]王文芳,陈秀慧,王德莹,等.宫腔镜联合子宫动脉栓塞术在剖宫产切口瘢痕妊娠中应用的可行性分析[J].实用妇产科杂志,2013,29:840-843.
[7]刘炳光,曹满瑞,张玉霞,等.子宫动脉栓塞与化疗栓塞治疗瘢痕妊娠疗效比较[J].介入放射学杂志,2015,24:588-591.
[8]顾祝新,黄健,赵辉,等.子宫瘢痕妊娠两种疗法的对照研究[J].介入放射学杂志,2015,24:625-628.
[9]张宇慧,周顺科.子宫肌瘤介入治疗近展[J].介入放射学杂志,2013,22:340-345.