摘要
目的 探讨宫腔镜联合子宫动脉栓塞术对剖宫产子宫瘢痕部位妊娠的诊疗作用。方法 回顾性分析我院2011年6月~2013年12月收治的60例剖宫产子宫瘢痕妊娠的临床资料。依据患者自身状况分为两组治疗方式,A组36例,行子宫动脉栓塞术后宫腔镜手术;B组24例,使用甲氨蝶呤静脉注射后宫腔镜下手术治疗。比较两组术中出血量、住院时间,分别于治疗前、子宫动脉栓塞术或静脉注射甲氨蝶呤后宫腔镜术前,采用彩超观察妊娠包块大小;治疗前、子宫动脉栓塞术或静脉注射甲氨蝶呤后1~2 d和宫腔镜术后每3~7 d,采用酶联免疫吸附法复查血β-h CG变化,直至恢复正常,患者月经来潮。结果 两组治疗前病灶大小、血β-h CG水平无统计学差异（P〉0.05）,两组行子宫动脉栓塞术或静脉注射甲氨蝶呤后1~3 d,病灶缩小,血β-h CG水平下降,宫腔镜术后血β-h CG水平显著下降,且A组比B组降低更显著（P〈0.05）。A组术中出血量少于B组（P〈0.05）。两组住院时间、术后血β-h CG恢复时间、恢复正常月经时间均无统计学差异（P〉0.05）。结论 宫腔镜联合子宫动脉栓塞术对剖宫产瘢痕部位妊娠安全有效,对患者损伤少,值得在临床推广。
Objective To investigate the diagnostic effects of hysteroscopy combined with uterine arterial embolization on patients with cesarean scar pregnancy. Methods Retrospective analysis was made in the clinical data of 60 cases of cesarean scar pregnancy that were hospitalized between June 2010 and December 2013. According to the patients＇ self conditions, they were divided into two treatment groups. Group A with 36 cases received hysteroscopy after uterine arterial embolization; group B with 24 cases received the hysteroscopy after intravenous injection with methotrexate. Comparison was made in the intraoperative blood loss and length of hospital stay between the two groups. The sizes of pregnancy masses were observed by color doppler ultrasound respectively before the treatment, after the uterine artery embolization or intravenous injection with methotrexate but before the hysteroscopy. The changes in the blood β-hCG were reexamined by enzyme-linked immunosorbent method before the treatment, one day to two days after the uterine artery embolization or intravenous injection with methotrexate, and every three to seven days after the hysteroscopy, until the levels returned to normal and the patients regained menstruai onset. Results Before the treatment, there was no significant difference in the focus sizes and blood β-hCG levels between the two groups （P 〉 0.05）. The focus sizes and blood β-hCG levels in the two groups declined one day to three days after the uterine arterial embolization or methotrexate injection with methotrexate. After the hysteroscopy, the blood β-hCG levels obviously declined, and the decline in group A was more significant than that in group B （P 〈 0.05）. The intraoperative blood loss of group A was less than that of group B （P 〈 0.05）. There was no significant difference in the mean hospital stay, blood β-hCG recovery time after the operation, and the recovery time to normal flow between the two groups （P 〉 0.05）. Conclusion Hysteroscopy combined with uterine art
出处
《西南国防医药》
CAS
2015年第7期727-729,共3页
Medical Journal of National Defending Forces in Southwest China
关键词
宫腔镜
瘢痕妊娠
子宫动脉
栓塞术
甲氨蝶呤
hysteroscope
scar pregnancy
uterine artery
embolization
methotrexate
