子宫动脉栓塞术治疗剖宫产术后切口妊娠临床观察.docVIP

子宫动脉栓塞术治疗剖宫产术后切口妊娠临床观察作者单位：611130 成都市温江区中医院通讯作者：赵红 【摘要】目的探讨子宫动脉栓塞术治疗剖宫产后切口妊娠的临床效果。方法剖宫产术后切口妊娠患者50例，按入院先后顺序随机分为观察组和对照组，每组25例。对照组采用MTX肌内注射后行刮宫术，观察组在子宫动脉栓塞术后行刮宫术。对两组治疗后的临床指标进行比较分析。结果观察组在出血量、住院时间、血hCG降至正常时间均少于对照组，差异有统计学意义(P0?05)。结论子宫动脉栓塞治疗切口妊娠能降低大出血风险，保留妇女生育功能，且具有疗效确切，安全，副反应轻的优点，优于MTX肌内注射后刮宫术，可作为剖宫产术后切口妊娠治疗的首选方法。【关键词】剖宫产后切口妊娠;子宫动脉栓塞术;MTX;治疗 Uterine artery embolization in the treatment for the cesarean scar pregnancyZHAO Hong.Wen jiang District Chinese medicine hospital,Chengdu 611130，China【Abstract】ObjectiveTo explore the clinical effect of uterine artery embolization (UAE)in the treatment for the cesarean scar pregnancy(CSP).MethodsBy order of admission,50 patients with CSP were randomly divided into observation group and control group (n=25).Observation group was underwent curettage after UAE in the treatment and control group was underwent curettage after intramuscular injection of MTX-line.The clinical indicators after treatment were compared between the two groups.ResultsControl group was higher than observation group in blood loss,hospital stay,time for blood HCG to normal,the difference was statistically significant (P0?05).ConclusionUAE is an effective,safe and minimally invasive method with low risk of heavy bleeding for the treatment of CSP superior to curettage after intramuscular injection of MTX and has important clinical value.【Key words】Cesarean section incision pregnancy;Uterine artery embolization;MTX;Treatmentdoi:10.3969/j.issn.1674-4985.2012.01.009切口妊娠(cesarean scar pregnancy，CSP)为较罕见的剖宫产后远期并发症之一［1］。近年来，随着剖宫产的日趋增多，这种特殊的异位妊娠发生率也有增加。早期不易诊断，如继续妊娠或诊断不明即行刮宫，极易发生无法控制的大出血、子宫破裂等，是一种非常危险的异位妊娠类型。故一经确诊，即应及时采取合适的方法终止妊娠。为探索良好的保守治疗方法，本院采用子宫动脉栓塞术后(UAE)行刮宫术治疗切口妊娠，疗效较佳，现在报告如下。1资料与方法 1?1一般资料对2006年5月～2011年5月，本院妇科收治的50例CSP患者按入院先后顺序随机分为观察组与对照组，每组25例。见表1。两组患者一般情况差异无统计学意义(P0?05)，具有可比性。对照组采用MTX肌内注射后行刮宫术，观察组在子宫动脉栓塞术后行刮宫 1?2诊断标准［2］（1）hCG测定：尿或血β-hCG阳性，测定值一般在100～10000 IU/L。（2）患者有剖宫产史，本次早孕有阴道流血，检查发现子宫下部增大膨胀。（3）超声：宫颈管内、官腔内、附件区未见孕囊，彩色超声波显示子宫下段切口部位处典型的孕囊声像，孕囊周边探及明显的环状血流信号