探讨剖宫产瘢痕妊娠(CSP)患者接受子宫动脉化疗栓塞术(UACE)联合超声引导下清宫术治疗，分别采用直径为560～710 μm聚乙烯醇颗粒(PVA)与500～710 μm明胶海绵颗粒(GP)为栓塞剂时，对患者清宫术中出血量的影响。

采用简单随机抽样方法，选择2015年7月1日至2019年3月1日，于四川大学华西第二医院放射科进行UACE联合超声引导下清宫术治疗的142例CSP患者为研究对象，其中Ⅱ、Ⅲ型CSP患者分别为102例、40例。按照CSP类型及UACE使用栓塞剂不同，将142例CSP患者分别纳入Ⅱ型PVA组(n＝51，Ⅱ型CSP患者，PVA栓塞剂)，Ⅱ型GP组(n＝51，Ⅱ型CSP患者，GP栓塞剂)，Ⅲ型PVA组(n＝20，Ⅲ型CSP患者，PVA栓塞剂)，Ⅲ型GP组(n＝20，Ⅲ型CSP患者，GP栓塞剂)。采用回顾性分析方法，收集所有患者的年龄、孕囊最大直径、入院时停经时间、孕次、剖宫产术分娩次数、术前人绒毛膜促性腺激素(hCG)水平、住院时间、清宫术中出血量等。采用Wilcoxon秩和检验或成组t检验，对Ⅱ型PVA组与Ⅱ型GP组，Ⅲ型PVA组与Ⅲ型GP组患者清宫术中出血量、住院时间进行比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

①Ⅱ型PAV组与Ⅱ型GP组、Ⅲ型PAV组与Ⅲ型GP组患者年龄、入院时停经时间、孕次、剖宫产术分娩次数、术前hCG水平等一般临床资料分别比较，差异均无统计学意义(P>0.05)。②Ⅱ型PAV组、Ⅲ型PAV组孕囊最大直径，分别长于Ⅱ型GP组、Ⅲ型GP组，并且差异均有统计学意义(t＝3.377、2.096，P＝0.001、0.043)。对孕囊最大直径与清宫术中出血量进行秩相关性分析的结果显示，Ⅱ型CSP患者孕囊最大直径与清宫术中出血量呈弱相关关系(r_s＝0.235，P＝0.017)，Ⅲ型CSP患者孕囊最大直径与清宫术中出血量相关性不显著(r_s＝0.295，P＝0.064)。③Ⅱ型PVA组、Ⅱ型GP组患者清宫术中出血量分别为10 mL(2～200 mL)与10 mL(2～100 mL)，住院时间分别为(5.3±1.5) d与(5.2±1.7) d，2组清宫术中出血量住院时间分别比较，差异均无统计学意义(P>0.05)；Ⅲ型PVA组、Ⅲ型GP组患者清宫术中出血量分别为(10.7±7.5)mL与(11.7±13.9)mL，住院时间分别为(5.5±1.1) d与(4.8±1.8) d，2组分别比较，差异亦均无统计学意义(P>0.05)。

UACE联合超声引导下清宫术中，采用PVA与GP栓塞剂，对于减少清宫术中出血量的效果相似。

To explore the effect of two different embolization agents polyvinyl alcohol particles (PVA) with a diameter of 560-710 μm and gelfoam particles (GP) with a diameter of 500-710 μm on the volumes of bleeding in uterine artery chemoembolization (UACE) combined with uterine curettage under ultrasound monitoring in pregnant women with caesarean scar pregnancy (CSP).

From July 1 of 2015 to March 1 of 2019, a total of 142 cases of CSP pregnant women who received UACE combined with uterine curettage under ultrasound monitoring in Department of Radiology, West China Second University Hospital, Sichuan University were selected as the research subjects by simple random sampling method, and there were 102 cases of CSP Ⅱ, and 40 cases of CSP Ⅲ. According to types of CSP and different embolization agents used in UACE, the 142 pregnant women with CSP were divided into type Ⅱ PVA group (n=51, CSP Ⅱ pregnant women with the use of PVA as embolization agents), type Ⅱ GP group (n=51, CSP Ⅱ pregnant women with the use of GP as embolization agents), type Ⅲ PVA group (n=20, CSP Ⅲ pregnant women with the use of PVA as embolization agents), type Ⅲ GP group (n=20, CSP Ⅲ pregnant women with the use of GP as embolization agents). The age, the maximum diameter of gestational sac, time of menopause at admission, gravidity, number of caesarean sections, levels of human chorionic gonadotropin (hCG) before operation, length of hospital stay, and volume of bleeding during uterine curettage of all pregnant women were collected by retrospective method. Wilcoxon rank sum test and independent-samples t test were used to compare the volume of bleeding during uterine curettage and length of hospital stay between type Ⅱ PVA group and type Ⅱ GP group, type Ⅲ PVA group and type Ⅲ GP group. This study was in line with the requirements of World Medical Association of Helsinki revised in 2013.

①There were no statistically significant differences between type Ⅱ PAV group and type Ⅱ GP group, type Ⅲ PAV group and type Ⅲ GP group in the age, time of menopause at admission, gravidity, number of caesarean sections, level of hCG before operation (P>0.05). ②The maximum diameters of gestational sac in type Ⅱ PAV group and type Ⅲ PAV group were longer than those in type Ⅱ GP group and type Ⅲ GP group, respectively, and both differences were statistically significant (t=3.377, 2.096; P=0.001, 0.043). The correlation analysis of the maximum diameter of gestational sac and volume of bleeding during uterine curettage showed that the maximum diameter of gestational sac of pregnant women with type Ⅱ CSP was weakly correlated with the volume of bleeding during uterine curettage (r_s=0.235, P=0.017), and in pregnant women with type Ⅲ CSP, there was no significant correlation between these two indexes (r_s=0.295, P=0.064). ③The volumes of bleeding during uterine curettage in type Ⅱ PVA group and type Ⅱ GP group were 10 mL (2-200 mL) and 10 mL (2-100 mL), respectively, and the length of hospital stay were (5.3±1.5) d and (5.2±1.7) d, respectively, and there were no statistically significant differences between these two groups in these two indexes (P>0.05). The volumes of bleeding during uterine curettage in type Ⅲ PVA group and type Ⅲ GP group were (10.7±7.5) mL and (11.7±13.9) mL, respectively, and the length of hospital stay were (5.5±1.1) d and (4.8±1.8) d, respectively, and there were no statistically significant differences between these two groups in these two indexes (P>0.05).

The effects of reducing the volume of bleeding during uterine curettage are the same with the use of PVA and GP as embolization agents to embolize bilateral uterine artery of CSP pregnant women in UACE combined with uterine curettage under ultrasound monitoring.