腹主动脉球囊阻断与子宫动脉栓塞作为剖宫产瘢痕妊娠术前预处理的临床研究

A clinical study of abdominal aortic balloon occlusion versus uterine artery embolization as the pretreatment for cesarean section scar pregnancy

摘要

目的 对比腹主动脉球囊阻断与子宫动脉栓塞作为剖宫产瘢痕妊娠（cesarean scar pregnancy，CSP）术前预处理的安全性和有效性。 方法 回顾性分析2018年1月至2019年12月成都市妇女儿童中心医院收治的临床和影像学确诊并在治疗前行预处理的CSP患者104例，其中47例患者在手术治疗前采用腹主动脉球囊阻断，57例患者在手术治疗前采用子宫动脉栓塞（uterine artery embolization，UAE）。 结果 2组患者基本情况及治疗效果差异无统计学意义（P>0.05）。2组患者在住院费用、介入术后疼痛、X线透视下介入操作辐射时间和体表辐射剂量、术后月经改变差异有统计学意义（P=0.034）。 结论 腹主动脉球囊阻断和UAE作为CSP术前预处理均可有效控制CSP患者术中出血，相较于UAE使医务人员及患者接受辐射的时间和辐射剂量减少，患者无严重盆腔痛，术后出现月经量及闭经的并发症减少，未发现对子宫和卵巢功能的近期影响，但是价格相对较高。

Abstract

Objective To investigate the safety and efficacy of abdominal aortic balloon occlusion versus uterine artery embolization（UAE） as the pretreatment for cesarean scar pregnancy（CSP）. Methods A retrospective analysis was performed for 104 patients with CSP who were admitted to Chengdu Women and Children's Central Hospital from January 2018 to December 2019 and were diagnosed based on clinical and radiological examinations，among whom 47 received abdominal aortic balloon occlusion before surgery and 57 received UAE before surgery. Results There were no significant differences in general information and treatment outcome between the two groups（P>0.05）. There were significant differences between the two groups in hospital costs，pain after interventional surgery，duration of interventional radiation and body surface radiation dose under X-ray fluoroscopy，and postoperative menstrual changes（P<0.05）. Conclusion Both abdominal aortic balloon occlusion and UAE can effectively control intraoperative bleeding as the pretreatment for CSP，and compared with UAE，abdominal aortic balloon occlusion significantly reduces the duration and dose of radiation for both medical staff and patients，with no severe pelvic pain and a few postoperative complications such as the reduction in menstrual volume and amenorrhea. Abdominal aortic balloon occlusion has no near-term effect on uterine and ovarian function，but with a relatively high price.

关键词

剖宫产瘢痕妊娠 / 腹主动脉球囊阻断 / 子宫动脉栓塞术

Key words

cesarean scar pregnancy / abdominal aortic balloon occlusion / uterine artery embolization

基金资助

四川省医学科研青年创新课题资助项目(Q17018)