关键词: 剖宫产瘢痕妊娠, 清宫术, 子宫动脉栓塞术, 人绒毛膜促性腺激素

Abstract: Objective To compare ultrasound-guided uterine curettage and uterine curettage after uterine artery embolization (UAE) for cesarean scar pregnancy(CSP)type I treatment. Methods We performed retrospective case control study,fifty-two patients were given ultrasound-guided uterine curettage as the study group,26 patients were given UAE followed by ultrasound-guided uterine curettage as the control group. Ultrasound examination was used for the diagnosis. Results The treatment success rate of the study group was 98%,and that of the control group was 100%. There was no significant difference of operation time and bleeding volume between the two groups. The decrease of serum human chorionic gonadotropin (HCG) both of two group were satisfactory. But at 1 day,7 days and 14days after operation, the decrease of serum HCG of study group was significantly slower than that of the control group. The time of blood HCG return to normal after operation of the study group and the control group was (24.38 ±9.23)days vs (19.12 ±4.23)days,and length of bleeding days after operation were (12.19±7.54)days and (8.58±3.01)days. The differences were significant. The days of menstrual recovery of the study group and the control group were (33.54 ±5.98)days and (32.69 ±5.13)days,respectively. There was no significant difference,but 30.8% menstrual reduction of the study group was significantly higher than 61.5% of the control group. In the study group,36.5% of abnormal mass in the lower anterior wall of uterine cavity can be found by ultrasound examination after the first menstruation was significantly higher than 15.4% that of the control group,but there was no difference of the size of the mass between the two groups. Conclusion CSP type I can be safely and effectively treated by ultrasound guided curettage. But surgery should be carried out in the hospital which are capable of salvage because bleeding risk of CSP is extremely high. For the treatment of CSP,monitoring the decrease of HCG is very important. Some patients showed slow descent of HCG in blood,which should be examined and treated promptly.

Key words: cesarean scar pregnancy, uterine curettage, uterine artery embolization, human chorionic gonadotropin