子宫动脉栓塞加超声引导刮宫术治疗瘢痕性剖宫产妊娠：单一三级医院5年经验。

IF 2 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Taiwanese Journal of Obstetrics & Gynecology Pub Date : 2025-01-01 DOI:10.1016/j.tjog.2024.09.021

Ying Feng , Huiqiao Gao , Fang Liu , Shuzhen Wang , Meizhu Xiao

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引用次数: 0

摘要

目的：探讨超声引导下子宫动脉栓塞加甲氨蝶呤和不加甲氨蝶呤的剖宫产瘢痕妊娠患者的即时治疗效果、后续生育效果和月经变化。材料与方法：本研究共纳入82例符合纳入标准的患者，分为两组。组50例采用子宫动脉栓塞+超声引导刮宫术，组32例采用子宫动脉栓塞+甲氨蝶呤+超声引导刮宫术。结果：两组患者人口学特征差异无统计学意义，但子宫动脉栓塞前、超声引导刮宫后1天、7天血清β-人绒毛膜促性腺激素水平明显高于1组。10例患者有生育欲望，半数失败，半数成功，其中一例复发性剖宫产瘢痕妊娠。多数患者（74.4%）无月经变化，19例患者月经减少，2例患者月经延长。结论：子宫动脉栓塞联合或不联合甲氨蝶呤+超声引导刮除术是剖宫产瘢痕妊娠患者消除妊娠囊同时保留生育能力的有效、安全、值得推荐的治疗方法，甲氨蝶呤可降低血中β-人绒毛膜促性腺激素水平，缩短恢复正常所需时间，从而缩短住院天数。

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Uterine artery embolization plus ultrasound guided curettage for cesarean scar pregnancy: Five-year experience at a single tertiary hospital

Objective

To study immediate therapeutic outcomes, subsequent fertility effects and menstrual changes in cesarean scar pregnancy patients who received uterine artery embolization with or without methotrexate followed by ultrasound guided curettage.

Materials and methods

Totally, 82 patients who met the inclusion criteria were enrolled in our study and divided into two groups. Group I included 50 patients who received uterine artery embolization and ultrasound guided curettage, and Group II had 32 patients who received uterine artery embolization plus methotrexate and ultrasound guided curettage.

Results

No significant difference was found in demographic features between the two groups, but the level of serum β-human chorionic gonadotropin before uterine artery embolization, 1 day and 7 days after ultrasound guided curettage is significantly higher in Group II than that in Group I. Patients were followed up for a mean time of 38.9 months. 10 patients had reproductive desire and half of them failed while half succeeded including one recurrent cesarean scar pregnancy. Most patients (74.4 %) had no menstrual changes, while 19 patients complaint a decrease in menstruation and 2 patients had a prolonged menstruation.

Conclusion

Uterine artery embolization combined with or without methotrexate plus ultrasound guided curettage is an effective, safe and recommended therapy to eliminate the gestational sac and meanwhile to preserve fertility for cesarean scar pregnancy patients, and methotrexate could help reduce the blood level of β-human chorionic gonadotropin and shorten the days to recover to normal, thus reducing hospitalized days.

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来源期刊

Taiwanese Journal of Obstetrics & Gynecology OBSTETRICS & GYNECOLOGY-

CiteScore

3.60

自引率

23.80%

发文量

207

审稿时长

4-8 weeks

期刊介绍： Taiwanese Journal of Obstetrics and Gynecology is a peer-reviewed journal and open access publishing editorials, reviews, original articles, short communications, case reports, research letters, correspondence and letters to the editor in the field of obstetrics and gynecology. The aims of the journal are to: 1.Publish cutting-edge, innovative and topical research that addresses screening, diagnosis, management and care in women''s health 2.Deliver evidence-based information 3.Promote the sharing of clinical experience 4.Address women-related health promotion The journal provides comprehensive coverage of topics in obstetrics & gynecology and women''s health including maternal-fetal medicine, reproductive endocrinology/infertility, and gynecologic oncology. Taiwan Association of Obstetrics and Gynecology.