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目的探讨剖宫产切口瘢痕妊娠患者采用宫腔镜及子宫动脉栓塞术(UAE)联合治疗的效果及安全性。方法选取2013年6月-2015年6月在该院治疗的剖宫产切口瘢痕妊娠患者36例为研究对象,所有患者入院时超声检查显示剖宫产切口瘢痕(最大直径)≤6 cm,均给予宫腔镜及子宫动脉注入甲氨蝶呤(MTX),在患者β-hCG下降至约1 000 U/L同时超声检查显示病灶与浆膜层厚≥0.2 cm时,在宫腔镜下将妊娠病灶切除。结果 36例患者UAE联合MTX动脉内注射的手术平均时间为(20.12±3.85)min,术中无副伤及特殊情况发生,患者生命体征均平稳正常。患者血β-hCG水平以及病灶直径均显著降低或缩小,治疗前后比较,差异均有统计学意义(t=8.578 6、2.259 2,P均<0.05)。术后2~4 d患者血β-hCG水平逐步降低至平均(113.45±36.14)U/L,患者均正常出院,术后30~45 d逐步恢复正常规律月经,疗效满意。结论采用宫腔镜及UAE对剖宫产切口瘢痕妊娠患者进行联合治疗,手术成功率高,术中出血量低,不良反应少,疗效满意,应注意宫腔镜手术理想“时机”的选择,即血β-hCG值降低至1 000 U/L范围,可作为临床治疗剖宫产切口瘢痕妊娠的一种安全、有效的手段。
Objective To investigate the effect and safety of hysteroscopic and uterine arterial embolization (UAE) combined with cesarean section scar pregnancy. Methods Thirty-six patients with cesarean scar pregnancy undergoing cesarean section in our hospital from June 2013 to June 2015 were enrolled. All patients underwent echocardiography with cesarean section scar (maximum diameter) ≤6 cm Methotrexate (MTX) was given to the hysteroscope and the uterine artery. When the β-hCG in the patient dropped to about 1 000 U / L and the thickness of the lesion and serosal thickness ≥0.2 cm at the same time by sonography, Excision of pregnancy lesions. Results The average time of operation of UAE combined with MTX arterial injection was (20.12 ± 3.85) min in 36 patients. There were no secondary injuries and special cases during operation. All patients’ vital signs were stable and normal. The level of β-hCG and the lesion diameter of patients were significantly decreased or decreased. There were significant differences between before and after treatment (t = 8.578 6,2.259 2, P <0.05). The level of β-hCG decreased gradually to an average of (113.45 ± 36.14) U / L from 2 to 4 days after operation. All the patients were discharged normally. The normal menstruation was gradually recovered from 30 to 45 days after operation, and the effect was satisfactory. Conclusions Hysteroscopy and UAE combined cesarean scar pregnancy patients with high success rate, low blood loss, fewer adverse reactions, the effect is satisfactory, we should pay attention to hysteroscopic surgery Choice, that is, blood β-hCG decreased to 1 000 U / L range, can be used as a clinical treatment of cesarean scar incision pregnancy a safe and effective means.