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目的评价子宫动脉栓塞(UAE)联合宫腔镜治疗剖宫产瘢痕妊娠(CSP)的手术效果及结局。方法回顾性分析2005年1月至2012年6月北京大学人民医院住院行UAE联合宫腔镜手术的41例CSP患者的临床资料。结果 41例患者UAE术后均成功实施了宫腔镜手术,平均手术时间(26.0±13.1)min(10～60min),平均手术出血量(24.0±4.2)ml(20～30ml),平均住院天数(5.2±1.6)d(3～8d)。宫腔镜下见胎囊为外突型4例(9.7%),外突型平均手术时间[(42.5±17.1)min]显著低于内生型[(22.8±9.0)min;P=0.001];外突型平均孕周[(8.7±3.0)周]显著低于内生型[(6.7±1.7)周;P=0.041];二者β-hCG值、瘢痕厚度及血流阻力指数(RI)比较,差异均无统计学意义(P>0.05)。术后轻度发热者占9.7%(4/41)、轻至中度下腹痛者占24.4%(10/41)。随访率95.1%(39/41),术后平均血β-hCG值恢复时间(2.6±2.2)周(1～8周);平均月经恢复正常时间(4.4±1.3)周(4～12周)。其中1例患者2次栓塞术后出现闭经,经人工周期治疗术后6个月月经恢复。术后妊娠2例,1例为正常宫内妊娠,因计划外行人工流产术;1例再次发生剖宫产瘢痕妊娠,再次UAE+宫腔镜手术治疗。结论子宫动脉栓塞联合宫腔镜治疗剖宫产瘢痕妊娠是一个可靠的治疗选择,在保留了患者生育功能的同时,具有成功率高、并发症少、住院时间及血β-hCG值恢复时间短的优点。
Objective To evaluate the effect and outcome of uterine artery embolization (UAE) combined with hysteroscopy in the treatment of cesarean scar pregnancy (CSP). Methods The clinical data of 41 CSP patients undergoing UAE combined hysteroscopic surgery from Peking University People’s Hospital from January 2005 to June 2012 were retrospectively analyzed. Results All the 41 patients underwent hysteroscopic surgery after UAE. The average operation time was (26.0 ± 13.1) min (10-60 min), mean operative bleeding volume was (24.0 ± 4.2) ml (20-30 mL), mean length of stay (5.2 ± 1.6) d (3 ~ 8d). Hysteroscopic see embryo sac in 4 cases (9.7%), the average length of surgery (42.5 ± 17.1 min) was significantly lower than the endogenous type [(22.8 ± 9.0) min; P = 0.001] ; Mean gestational weeks (8.7 ± 3.0) weeks were significantly lower than that of endometriosis [(6.7 ± 1.7) weeks; P = 0.041]; β-hCG values, scar thickness and blood flow resistance index ), The differences were not statistically significant (P> 0.05). Postoperative mild fever accounted for 9.7% (4/41), mild to moderate lower abdominal pain accounted for 24.4% (10/41). The mean follow-up rate was 95.1% (39/41), mean postoperative mean recovery time of β-hCG was 2.6 ± 2.2 weeks (1-8 weeks), average menstrual recovery time was 4.4 ± 1.3 weeks (4-12 weeks) . One patient had amenorrhea after 2 embolizations, and menstruation recovered 6 months after artificial cycle treatment. Postoperative pregnancy in 2 cases, 1 case of normal intrauterine pregnancy, due to planned abortion abortion; 1 case of cesarean scar pregnancy again, again UAE + hysteroscopic surgery. Conclusion Uterine arterial embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy is a reliable treatment option, while retaining the patient’s reproductive function, with a high success rate, fewer complications, length of stay and blood β-hCG recovery time is short The advantages.