目的 探讨子宫动脉栓塞后清宫在剖宫产子宫疤痕妊娠(CSP)治疗中的价值.方法 对29例确诊为剖宫产子宫疤痕妊娠的患者实施子宫动脉栓塞后,在超声引导下行清宫治疗并进行分析.结果 29例子宫动脉栓塞后清宫治疗的患者术中出血10~100mL,20~80min完成手术,术后均无宫内残留,术后3~7天血β-hCG成倍数下降,全部患者在术后25~40天月经复潮,治疗有效率为100.00%.孕囊深侵及肌层的患者术中出血量和手术用时均明显多于妊娠囊较浅的患者(均P<0.05).(分别为P=0.031<0.05、P=0.001<0.05).各种类型CSP术后血β-hCG恢复正常的时间及月经复潮时间均无显著性差异(均P>0.05).结论 采用子宫动脉栓塞后剖宫产子宫疤痕妊娠清宫治疗,是治疗CSP的一种安全、有效的方法,同时要注意区分不同CSP的类型.%Objective To evaluate the effects of curettage treatment after uterine artery embolization in cesarean scar pregnancy ( CSP ). Methods Twenty-nine patients diagnosed as CSP received curettage treatment after uterine artery embolization under ultrasound guidance. And their outcomes were analyzed. Results The intraoperative bleeding of 29 cases receiving curettage treatment after uterine artery embolization was 10 to 100mL, and the operation duration was 20 to 80min. No intrauterine residue was left after operation, and β-hCG level dropped exponentially in 3 to 7 days after curettage. All of the patients recovered their menses at 25 to 40 days after operation, and the effective rate of treatment was 100.00% . The amount of intraoperative bleeding was more and operation time was longer significantly in patients whose gestation sac implanted deeply in cesarean scar than those in patients whose gestation sac did not implant or implant shallowly in cesarean scar( P =0.031 <0. 05, P =0.001 <0. 05 ). There were no significant differences in the time of serum β-hCG level returning to normal and menstruation recovering in all kinds of CSP patients ( both P >0.05 ). Conclusion The treatment of curettage after uterine artery embolization is a safe and effective method for CSP, and different CSP types need to be distinguished at the same time.
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