关键词: 米非司酮, 甲氨蝶呤, 子宫动脉栓塞术, 宫腔镜, 刮宫术, 剖宫产瘢痕妊娠

Abstract: Objective：To explore the effect of pharmacological preconditioning and uterine arterial embolization on the curative effect of hysteroscopic uterus curettage for cesarean scar pregnancy (CSP). Methods：The clinical data of 120 patients with CSP treated in the department of gynaecology of Xinyang Central Hospital of Henan Province from January 2016 to November 2017 were collected retrospectively. According to different treatment methods, the patients were divided into the study group (72 cases) and the control group (48 cases). The two groups were treated by pharmacological preconditioning with mifepristone + methotrexate (MTX) and uterine arterial embolization, respectively, and then they were treated by hysteroscopic uterus curettage. The completion of operation, postoperative recovery progress and occurrence of complications were observed and statistically analyzed. Results：There was no statistically significant difference in the incidence of secondary uterus curettage, massive hemorrhage, conversion to laparotomy or hysterectomy, operative time or intraoperative blood loss between the 2 groups (P＞0.05). The postoperative length of hospital stay, vaginal bleeding time, menstrual recovery time and blood β-subunit of human chorionic gonadotropin (β-HCG) recovery time of the study group were significantly shorter than those of the control group (P＜0.05). In the study group, the main complications were gastrointestinal reactions, and the incidence rate (22.22%) was significantly higher than that in the control group (7.14%) (P＜0.05). The incidence rates of fever and pain in the control group (18.75% and 33.33%) were significantly higher than those in the study group (2.78% and 8.33%) (P＜0.05). There was no statistically significant difference in the incidence of infection, liver function damage, intrauterine adhesion or uterine perforation between the 2 groups (P＞0.05). Conclusions：The application of pharmacological preconditioning with mifepristone+ MTX before hysteroscopic uterus curettage could improve the clinical curative effect of patients with CSP. Postoperative recovery is fast and complications are few. Attention should be paid to control of complications such as gastrointestinal reactions.

Key words: Mifepristone；, Methotrexate, Uterine arterial embolization, Hysteroscope, Dilatation and curettage, Cesarean scar pregnancy