Zhang J H, Duan H J, Zhao Y P, Hou Y H, Han X W, Liu N, Hu K, Feng Z P, Guo R X
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, China.
Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, China.
Zhonghua Fu Chan Ke Za Zhi. 2020 Aug 25;55(8):516-520. doi: 10.3760/cma.j.cn112141-20191209-00663.
To explore the clinical value by analyzing the application of abdominal aortic balloon occlusion in the uterine curettage treatment for patients with cesarean scar pregnancy (CSP). Totally 42 CSP patients in the first Affiliated Hospital of Zhengzhou University were analyzed retrospectively, 21 cases in the observation group, placing the balloon catheter to the abdominal aorta under the renal artery under the digital substraction angiography(DSA), conducting curettage under hysteroscopy or uterine laparoscopy immediately, and making intermittent blockage in abdominal aorta blood flow during the surgery;21 patients in the control group, conducting uterine artery embolization (UAE) before operation, conducting curettage under hysteroscopy or uterine laparoscopy after 1-3 days. The fluoroscopy time under DSA, body surface radiation dose, intraoperative blood loss, operation time, incidence of postoperative adverse reactions, hospitalization time and follow-up menstruation were comparatively analyzed. All patients operated and retained the uterus successfully. In the control group, all 21 patients had different degrees of fever, pain and other symptoms after UAE. In the observation group and control group, the fluoroscopy time and body surface radiation dose under DSA respectively were (7.4±1.4) s, (5.4±1.1) mGy and (1 142.8±315.5) s, (1 442.0±300.0) mGy (both <0.01);the average amount of intraoperative blood loss were (22±15), (19±14) ml (>0.05), the time of uterine curettage were (37±20), (42±19) minutes (>0.05);hospitalization time were (5.0±0.9), (7.7±1.3) days (<0.01). The follow-up period was more than 3 months, no adverse reactions were observed in the observation group; 4 cases of menstrual reduction and 1 case of intrauterine adhesions were found in the control group. Abdominal aortic balloon occlusion and UAE could effectively reduce intraoperative bleeding in uterine curettage for patients with CSP; abdominal aortic balloon occlusion has significant reduction of the X-ray dose, shorter hospitalization time, and fewer adverse events comparing to UAE.
通过分析腹主动脉球囊阻断术在剖宫产瘢痕妊娠（CSP）患者刮宫治疗中的应用来探讨其临床价值。回顾性分析郑州大学第一附属医院的42例CSP患者，观察组21例，在数字减影血管造影（DSA）引导下将球囊导管置于肾动脉水平以下的腹主动脉，随即在宫腔镜或子宫腹腔镜下刮宫，并在手术过程中对腹主动脉血流进行间歇性阻断；对照组21例，术前进行子宫动脉栓塞术（UAE），1 - 3天后在宫腔镜或子宫腹腔镜下刮宫。比较分析DSA下透视时间、体表辐射剂量、术中出血量、手术时间、术后不良反应发生率、住院时间及随访月经情况。所有患者均成功手术并保留子宫。对照组21例患者在UAE术后均出现不同程度的发热、疼痛等症状。观察组和对照组DSA下透视时间分别为（7.4±1.4）s、（5.4±1.1）mGy和（1 142.8±315.5）s、（1 442.0±300.0）mGy（均P<0.01）；术中平均出血量分别为（22±15）、（19±14）ml（P>0.05），刮宫时间分别为（37±20）、（42±19）分钟（P>0.05）；住院时间分别为（5.0±0.9）、（7.7±1.3）天（P<0.01）。随访3个月以上，观察组未见不良反应；对照组发现4例月经量减少及1例宫腔粘连。腹主动脉球囊阻断术和UAE均可有效减少CSP患者刮宫术中出血；与UAE相比，腹主动脉球囊阻断术可显著降低X线剂量及缩短住院时间，且不良事件更少。
