CAJ | 학술논문

目的：分析子宫动脉栓塞术辅助的清宫术治疗38例瘢痕子宫妊娠（CSP）的疗效和安全性，并进一步分析预防性手术和挽救性手术对手术疗效的影响。方法收集因CSP行子宫动脉栓塞术辅助清宫术治疗38例患者的临床资料，其中行预防性手术32例（预防组）、挽救性手术6例（挽救组），以是否进行子宫部分切除术为该研究的主要终点，比较子宫动脉栓塞术前2组CSP患者的基线特征，分析预防性手术与挽救性手术对避免子宫切除术的价值。结果子宫栓塞术前，2组CSP患者的基线特征基本一致，但挽救性子宫动脉栓塞组患者的人绒毛膜促性腺激素（HCG）和血红蛋白水平较低（P＜0.05）。预防性子宫动脉栓塞组患者均安全完成超声引导下清宫术，无一例发生大出血或进行子宫部分切除；挽救性子宫动脉栓塞组有3例因无法止血而进行了子宫部分切除术。两组行子宫部分切除术比例比较差异有统计学意义（P＜0.01）。子宫动脉栓塞术安全性良好，未进行子宫切除的患者约于术后2个月恢复月经。结论子宫动脉栓塞术辅助清宫术应用于CSP患者可以预防清宫术后大出血，且预防性子宫动脉栓塞术对避免子宫切除的疗效明显优于挽救性子宫动脉栓塞术。
목적：분석자궁동맥전새술보조적청궁술치료38례반흔자궁임신（CSP）적료효화안전성，병진일보분석예방성수술화만구성수술대수술료효적영향。방법수집인CSP행자궁동맥전새술보조청궁술치료38례환자적림상자료，기중행예방성수술32례（예방조）、만구성수술6례（만구조），이시부진행자궁부분절제술위해연구적주요종점，비교자궁동맥전새술전2조CSP환자적기선특정，분석예방성수술여만구성수술대피면자궁절제술적개치。결과자궁전새술전，2조CSP환자적기선특정기본일치，단만구성자궁동맥전새조환자적인융모막촉성선격소（HCG）화혈홍단백수평교저（P＜0.05）。예방성자궁동맥전새조환자균안전완성초성인도하청궁술，무일례발생대출혈혹진행자궁부분절제；만구성자궁동맥전새조유3례인무법지혈이진행료자궁부분절제술。량조행자궁부분절제술비례비교차이유통계학의의（P＜0.01）。자궁동맥전새술안전성량호，미진행자궁절제적환자약우술후2개월회복월경。결론자궁동맥전새술보조청궁술응용우CSP환자가이예방청궁술후대출혈，차예방성자궁동맥전새술대피면자궁절제적료효명현우우만구성자궁동맥전새술。
Objective To evaluate the efficacy and safety of uterine artery embolization (UAE)in the treatment of 38 cases of cesarean scar pregnancy (CSP),and further to explore the influence of preventive and rescue UAE upon surgical efficacy. Methods Clinical data from 38 CSP patients receiving UAE were col-lected,32 cases receiving preventive UAE before uterine curettage (preventive UAE group)and 6 undergoing rescue UAE after uterine curettage (rescue UAE group). Whether hysterectomy was performed was regarded as the main endpoint. Baseline characteristics of patients between two groups were statistically compared prior to UAE. The effect of preventive and rescue UAE on the necessity of hysterectomy was evaluated. Results Be-fore UAE,baseline characteristics of patients between two groups were almost the same. However,patients in the rescue group presented with significantly lower human chorionic gonadotropin (HCG)and hemoglobin lev-els compared with their counterparts in the preventive group (both P<0.05 ). Patients receiving preventive UAE successfully underwent ultrasound-assisted uterine curettage. No cases underwent hysterectomy due to se-vere bleeding. In the rescue group,3 patients received hysterectomy for excessive bleeding. The number of pa-tients undergoing hysterectomy significantly differed between two groups (P<0.01 ). The safety of UAE was assured. Patients who did not undergo hysterectomy had menstruation within postoperative 2 months. Conclu-sion UAE combined with uterine curettage could effectively prevent excessive bleeding. Preventive UAE pres-ented with better effect on avoiding subsequent hysterectomy compared with rescue UAE.