关键词: 妊娠, 异位, 子宫动脉栓塞术, 明胶海绵, 吸收性, 甲氨喋呤

Abstract:

Objective： To analyze the clinical value and prognosis of cesarean scar pregnancy (CSP) treated by uterine artery embolization (UAE). Methods： In the study, 492 cases of patients in Nanjing Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University diagnosed as CSP between January 2011 and December 2014 were chosen, of which 283 were of high-risk group and 209 of low-risk group. According to whether to take UAE, the high-risk group was subdivided into high-risk UAE group(UAE+laparoscopic group), 167 cases, and high-risk non UAE group (chemotherapy+laparoscopic group), 116 cases, while the low-risk group was subdivided into low-risk UAE group (UAE+curettage group), 113 cases, and low-risk non UAE group(chemotherapy+curettage group), 96 cases. The differences of the intraoperative bleeding, length of stay, blood beta human chorionic go-nadotropin (βHCG) dropped to normal time, menstruation recovery time and the hospitalization expenses were compared. And multivariate regression analysis was used to predict the recurrence risk of CSP. Results： The high-risk UAE group was better than the high-risk non UAE group in comparison of intraoperative bleeding ［(36.5±14.8) mL vs.(76.5±39.7) mL］, length of stay ［(5.9±0.9) d vs.(9.6±1.3) d］, blood β-HCG dropped to normal time ［(17.9±8.7) d vs.(28.7±10.1) d］ and menstruation recovery time ［(18.1±1.6) d vs.(24.3±1.8) d］,while the low-risk UAE group was better than the low-risk non UAE group in comparison of intraoperative bleeding ［(93.2±43.3) mL vs.(284.8±110.5) mL］, length of stay ［(10.2±1.4) d vs. (30.7±9.6) d］, blood β-HCG dropped to normal time ［(50.1±17.6)d vs.(67.5±22.9)d］ and menstruation recovery time［(56.3±6.7)d vs.(65.9±9.3) d］, all P<0.05. The highrisk UAE group was higher than the high-risk non UAE group in comparison of hospitalization expenses ［(20 140±1 520 )Yuan vs.(13 510±1 013) Yuan］, and the low-risk group UAE was also higher than the low-risk non UAE group in comparison of hospitalization expenses ［(10 095±962 )Yuan vs.(3 890±457) Yuan］, all P<0.01. Multivariate Logistic regression analysis showed that the treatment method was independent predictor of CSP recurrence risk (OR 2.407, 95%CI 1.176-5.092, P<0.05), and using the comprehensive treatment including UAE could reduce the risk of recurrent CSP. Conclusion： As the efficacy of interventional therapy for CSP was rapid and reliable, fewer complications, faster recovery and lower recurrence, hospitalization with good conditions, and particularly for those patients with CSP who want to fertility again, the comprehensive treatment including UAE treatment should be the first choice.

Key words: Pregnancy, ectopic, Uterine artery embolization, Gelatin sponge, absorbable, Methotre-xate