Qian Zhi-Da, Huang Li-Li, Zhu Xiao-Ming
Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006, Zhejiang Province, People's Republic of China.
Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, People's Republic of China.
Arch Gynecol Obstet. 2015 Nov;292(5):1055-61. doi: 10.1007/s00404-015-3730-1. Epub 2015 May 3.
To compare the clinical effects of dilatation and curettage (D&C) regimen and operative hysteroscopy coupled with curettage regimen in the treatment of cesarean scar pregnancy (CSP) following preventive uterine artery embolization (UAE).
Thirty-three women were treated with D&C after UAE (group A) and 33 women were treated with operative hysteroscopy coupled with curettage after UAE (group B). The clinical outcomes of the two groups were compared.
There was no significant difference between the two groups with respect to the success rate, the intraoperative blood loss, the hysterectomy rate, the hospitalization time, the decline of serum β-hCG after surgery, the time of serum β-hCG resolution, the time of vaginal bleeding after surgery, the time to CSP mass disappearance, and the subsequent intrauterine pregnancies. The hospitalization cost in group B was higher than group A.
Both D&C and operative hysteroscopy coupled with curettage were successful in terminating a CSP. Hysteroscopy coupled with curettage regimen did not have significant advantages and good prognosis in dealing with the gestational sac type of CSP following preventive UAE compared with D&C regimen. Treatment should be individualized and several conditions must be considered.
比较扩张刮宫术（D&C）方案与宫腔镜手术联合刮宫术方案在预防性子宫动脉栓塞术（UAE）后治疗剖宫产瘢痕妊娠（CSP）中的临床效果。
33例女性在UAE后接受D&C治疗（A组），33例女性在UAE后接受宫腔镜手术联合刮宫术治疗（B组）。比较两组的临床结局。
两组在成功率、术中出血量、子宫切除率、住院时间、术后血清β-hCG下降情况、血清β-hCG恢复正常时间、术后阴道出血时间、CSP包块消失时间以及后续宫内妊娠方面无显著差异。B组的住院费用高于A组。
D&C和宫腔镜手术联合刮宫术均成功终止了CSP。与D&C方案相比，宫腔镜手术联合刮宫术方案在预防性UAE后处理CSP孕囊类型方面没有显著优势和良好预后。治疗应个体化，必须考虑多种情况。
