Clinical Efficacy Of Bilateral Uterine Artery Embolization Or Uterine Artery Descending Branch Block Combined With Curettage In Patients With Uterine Scar Pregnancy After Curettage

Objective To compare the clinical effects of bilateral uterine artery embolization combined with curettage and laparoscopic uterine artery descending branch block combined with curettage on uterine scar pregnancy after curettage.Methods Patients with curettage on uterine scar pregnancy after curettage who received bilateral uterine artery embolization combined with curettage or uterine artery descending branch block combined with curettage in our hospital in 2012-2017 were retrospectively analyzed,including 49 cases in bilateral uterine artery embolization with curettage group and 47 cases in uterine artery descending branch block combined with curettage group.Age,number of pregnancy and curettage,interval after curettage till this pregnancy,type of history of previous pelvic surgery,pregnancy time,surgical bleeding,operation time,hospitalization duriation,hospitalization expense,time for postoperative blood HCG to recover normal,time for postoperative vaginal bleeding and complications were statistically analyzed.Results(1)The age,number of previous pregnancy,number of curettage,previous curettage(lower uterine segment curettage),interval after curettage till this pregnancy,uterine scar pregnancy,gestational days,?-HCG in serum blood,The size of the lesion,vaginal bleeding history and lower abdominal pain symptoms and other clinical data were not significantly different(P> 0.05).(2)The operation time in uterine artery descending branch block combined with curettage group was significantly longer than that in bilateral uterine artery embolization with curettage group,and the quantity of bleeding during operation in uterine artery descending branch block combined with curettage group was significantly more than that in bilateral uterine artery embolization with curettage group(P<0.05).(3)The operative success ratio was not significantly different in two groups(P>0.05)The duration of vaginal bleeding,time for ?-HCG in menstrual blood to recover normal and time for menstruation recovery in uterine artery descending branch block combined with curettage group was significantly shorter than those in bilateral uterine artery embolization with curettage group(P<0.05).(4)The hospitalization days in uterine artery descending branch block combined with curettage group were significantly shorter than those in bilateral uterine artery embolization with curettage group,and the hospitalization expense in uterine artery descending branch block combined with curettage group were significantly less than that in bilateral uterine artery embolization with curettage group(P <0.05).(5)Postoperative complications mainly included postoperative fever,postembolism syndrome,postoperative pain,intraoperative proximal organ injury,postoperative bleeding and cervical canal adhesions.However,the incidence of each postoperative complication and total postoperative complications in both groups were not significantly different(P> 0.05).Conclusion(1)Treatment of bilateral uterus artery embolization combined with curettage with retention characteristics of reproductive function,less trauma,less bleeding,less adverse reactions.In the case of bleeding,the patient is in critical condition,bilateral uterus artery mbolization can be used to quickly control bleeding and stable condition,but the hospital stay is more longer.(2)Treatment of laparoscopic bilateral uterine artery ligation combined with curettage with rapid recovery,short hospital stay,reservation of fertility function.But operation time is extended and bleeding amount is high,so the surgeon laparoscopic technology requirements are very high,it is difficult to promote in primary hospitals.