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目的对比宫腔镜下清宫术联合双侧子宫动脉栓塞术(UAE)与宫腔镜下清宫术联合甲氨蝶呤(MTX)对剖宫产瘢痕子宫妊娠(CSP)的治疗效果。方法回顾性分析2014年8月-2016年5月在湖南省妇幼保健接受治疗的剖宫产瘢痕子宫妊娠患者的临床资料,根据其治疗方式分为宫腔镜下清除术+UAE组(UAE组)和宫腔镜下清除术+MTX肌内注射组(MTX组)。观察两组血清人绒毛膜促性腺激素(HCG)转阴、瘢痕处包块消失和月经恢复时间,比较两组住院期间一般情况和不良反应发生率的差别。结果 UAE组手术时间较MTX组短,术中出血量较MTX组少;UAE组HCG转阴时间较MTX组短,两组的月经恢复时间无明显差别;UAE组患者的平均住院时间较MTX组短,住院费用较MTX组多;两组子宫穿孔、阴道流血和下腹痛发生率差异无统计学意义(χ2=1.046,P=0.306);两组患者治疗前生活质量得分差异无统计学意义;治疗后,UAE组患者的生活质量得分高于MTX组。结论宫腔镜下清宫术联合UAE对剖宫产瘢痕妊娠有较好的治疗效果,且症状体征恢复时间短,具有临床推广应用价值。
Objective To compare the therapeutic effect of hysteroscopic curettage combined with bilateral uterine artery embolization (UAE) and hysteroscopic curettage combined with methotrexate (MTX) on cesarean scar pregnancy. Methods The clinical data of patients undergoing cesarean scar pregnancy from March 2014 to May 2016 in Hunan Province were retrospectively analyzed. They were divided into hysterectomy + UAE group (UAE group) ) And hysteroscopic removal + MTX intramuscular injection group (MTX group). Serum human chorionic gonadotropin (HCG) was negative, the disappearance of mass and the recovery period of menstrual cramps in both groups were observed. The differences between the two groups in the general condition and the incidence of adverse reactions were compared. Results The operative time of UAE group was shorter than that of MTX group and the amount of bleeding during operation was less than that of MTX group. HCA-negative time of UAE group was shorter than that of MTX group. There was no significant difference between the two groups in the duration of menstruation recovery. Short and hospitalization costs were higher than those in MTX group. There was no significant difference in incidence of uterine perforation, vaginal bleeding and lower abdominal pain between the two groups (χ2 = 1.046, P = 0.306). There was no significant difference in quality of life before treatment between the two groups; After treatment, the quality of life scores of UAE patients were higher than that of MTX patients. Conclusion hysteroscopic curettage combined with UAE cesarean scar pregnancy have a better therapeutic effect, and the recovery time of symptoms and signs is short, with clinical application value.