Uterine artery chemoembolization and systemic methotrexate in treating cesarean scar pregnancy of different MRI types

doi:10.3877/cma.j.issn.2095-5782.2017.03.002

Abstract

Abstract:

Objective:

To study various types of MRI imagings of cesarean scar pregnancy (CSP), and to evaluate their significance in clinical application. Also, the indications, efficacy and safety of methotrexate (MTX) combined with uterine curettage and uterine artery chemoembolization (UACE) combined with curettage in the treatment of different types of CSP were as well studied.

Methods:

Clinical data of 187 patients with CSP treated in our hospital were retrospectively analyzed. They were divided into four groups according to different MRI types and treatments: Group A1 (CSPI patients treated by MTX combined with curettage), 45 patients; group B1( CSPI patients treated by UACE combined with curettage ), 12 patients; group A2 (CSPII patients treated by MTX combined with curettage), 40 patients; and group B2 (CSPII patients treated by UACE combined curettage), 90 patients. Their relative clinical data and follow-up results were statistically analyzed.

Results:

The blood loss during curettage showed no difference in both group A1 and group B1, while the number of patients with β-hCG decreased by more than 50% in the first day after curettage, and abnormal liver function rate, hysterectomy rate and treatment success rate all showed no significant difference. However, hospital stay in group A1 was much longer than in group B1, with significant difference. Group A2 and group B2 were seen a significant difference in blood loss during curettage, hospital stay, abnormal liver function rate, hysterectomy rate, decreased β-hCG decreased in the first day after curettage and treatment success rate.

Conclusion:

MRI can not only diagnose CSP, but also can confirm its different types, thus, it has an important clinical significance for the treatment of CSP. UACE combined with curettage had better effect than MTX combined with curettage in the treatment of CSP patients, especially for CSPII patients, and it should be the first choice for the patients with CSPII.

Key words: Uterine artery embolization, Methotrexate, Cesarean scar pregnancy, Magnetic resonance imaging

Kui Li, Guohui Yan, Yu Zou. Uterine artery chemoembolization and systemic methotrexate in treating cesarean scar pregnancy of different MRI types[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2017, 05(03): 128-134.

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Figures/Tables 6

References 19

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组别	例数	年龄(岁)	距上次怀孕时间(年)	孕次(次)	产次(次)	停经时间(d)	术前β-hCG(×10⁴ IU/L)	CSP肿块长径(cm)	CSP合并心搏*	阴道流血
A组	85	32.78±4.64	3.13±2.68	3.51±1.30	1.31±0.52	50.48±13.83	3.80	2.64±0.93	40（47.1）	49（57.6）
B组	102	33.25±4.59	3.51±3.26	3.25±1.33	1.23±0.46	54.23±15.73	4.78	2.87±1.08	57（55.9）	71（69.6）
统计量	?	t=0.706	t=0.856	t=1.350	t=1.283	t=1.716	t=1.268	Z=1.564	χ²=1.446	χ²=2.885
P值	?	0.481	0.393	0.179	0.201	0.088	0.206	0.119	0.229	0.089

组别	例数	年龄(岁)	距上次怀孕时间(年)	孕次(次)	产次(次)	停经时间(d)	术前β-hCG(×10⁴ IU/L)	CSP肿块长径(cm)	CSP合并心搏*	阴道流血
A组	85	32.78±4.64	3.13±2.68	3.51±1.30	1.31±0.52	50.48±13.83	3.80	2.64±0.93	40（47.1）	49（57.6）
B组	102	33.25±4.59	3.51±3.26	3.25±1.33	1.23±0.46	54.23±15.73	4.78	2.87±1.08	57（55.9）	71（69.6）
统计量	?	t=0.706	t=0.856	t=1.350	t=1.283	t=1.716	t=1.268	Z=1.564	χ²=1.446	χ²=2.885
P值	?	0.481	0.393	0.179	0.201	0.088	0.206	0.119	0.229	0.089

组别	例数	术中出血量(ml)	住院时间(d)	术后第1天血β-hCG下降超过50%者	肝功能异常者	子宫切除	治疗成功
A组	85	246.54	13.48±1.58	72（84.7）	15（17.6）	8（9.1）	64（75.3）
B组	102	128.99	6.73±1.65	96（94.1）	3（2.9）	2（1.9）	89（87.3）
统计量	?	Z=6.402	t=11.595	χ²=4.499	χ²=11.526	χ²=5.085	χ²=4.459
P值	?	<0.001	<0.001	0.034	0.001	0.024	0.035

组别	例数	术中出血量(ml)	住院时间(d)	术后第1天血β-hCG下降超过50%者	肝功能异常者	子宫切除	治疗成功
A组	85	246.54	13.48±1.58	72（84.7）	15（17.6）	8（9.1）	64（75.3）
B组	102	128.99	6.73±1.65	96（94.1）	3（2.9）	2（1.9）	89（87.3）
统计量	?	Z=6.402	t=11.595	χ²=4.499	χ²=11.526	χ²=5.085	χ²=4.459
P值	?	<0.001	<0.001	0.034	0.001	0.024	0.035

组别	例数	术中出血量(ml)	住院时间(d)	术后第1天血β-hCG下降超过50%者	肝功能异常者	子宫切除	治疗成功
A1组	45	129.13	13.56±1.66	42（93.33）	8（17.78）	3（6.67）	41（91.11）
B1组	12	162.92	7.33±1.83	11（91.37）	1（8.33）	0（0）	11（91.67）
统计量	?	Z=0.060	t=5.307	χ²=0	χ²=0.124	χ²=0.037	χ²=0
P值	?	0.952	<0.001	1	0.725	0.848	1

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