子宫动脉栓塞术联合清宫术对比甲氨蝶呤治疗Ⅱ型剖宫产瘢痕妊娠的效果与生育结局

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[中图分类号]R713.8 [文献标志码]A [文章编号] 1674-7887（2025）04-0353-04

Comparison of uterine artery embolization combined with curettage versus methotrexate in the treatment of type I cesarean scar pregnancy： efficacy and reproductive outcomes*

SUN Yanjunl**，GU Zhuxin²，YING Haiyan** （'Department of Obstetrics and Gynecology，Yancheng Tinghu District People'sHosital，su24o;eparmntofevetialndslarurgeryfledHspialftoUiy [Abstract]Objective：Tocomparethecliniceficacyandlong-termreproductiveoutcomesoflocalmethotrexate（MTX）injectionversusuterinearteryembolization（UAE）combinedwithultrasound-gudedcuretage（UGC）inthetreatmentftypeIesarean scarpregnancy（CSP）.Methods：Thisretrospectivestudyincluded93patients diagnosedwithtypeICSPbetweenFebruary014 andJune2O19atYanchengTinghuDistrictPeople'sHospitalandAfiliatedHospitalofNantongUniversity.Thirty-twopatients received MTX therapy，while 61patientsunderwent UAE combined with UGC.A comparison was made between thetwo groups regarding primary outcomes [including treatment success rate（defined as normalization of serum β -human chorionic gonadotropinlevelsandultrasonographicrevealedthatthelesionwasnolongeracsualized），ospitalizationduration，andcomplicationrates]，aswellassecondaryoutcomes（encompassing menstrual paternsandertitystatusduringafowupperiod of 5to9years）. Results： The UAEcombined with UGC group demonstrated significantly higher treatment success rates（ 100.0% （204 Vs 53.1% ， P<0.05 ），shorter hospitalization duration[（3.50±1.48） d vs （13.01±5.26） d， P<0.05 ）]，and a trend toward reduced complications（11.5% vs 31.2% ， P⋅ =0.41）compared with the MTX group.Long-term follow-up revealed a higher incidence of menstrual volume reduction（57.4% vs 6.2 % ）and lower fertility success rates（57.1% vs 100.0% ）in theUAE combinedwithUGC group. In the MTX group，15 case（46.9 % ） required additional interventions，including9casesconverted to UAE combined with UGCfordefinitivecure.Conclusion： UAEcombined with UGC significantlyimprovestreatmenteficacyandreduces hospitalizationdurationfortypeICSPbutmayadverselyafectmenstrualandfertilityoutcomes.MTXremainssuitableforearlyor low-risk cases， while a stepped-care combination approach is recommended for refractory CSP.

[KeyWords]cesareanscarpregnancy;uterinearteryembolization;ultrasound-gudedcurettage;methotrexate;fertilityout comes

剖宫产瘢痕妊娠（cesarean scar pregnancy， CSP）是一种高危异位妊娠，定义为妊娠囊植入既往剖宫产切口处的子宫肌层或纤维瘢痕组织内。（剩余7454字）