经子宫动脉灌注和栓塞治疗输卵管妊娠  

Treatment of tubal pregnancy by uterine artery perfusion and embolization

作　　者：倪才方[1] 邹建伟[1] 赵辉[1] 金泳海[1] 朱晓黎[1] 刘一之[1] 何琦[2] 沈仲姬[2] 

机构地区：[1]苏州大学附属第一医院介入科,江苏苏州215006 [2]苏州大学附属第一医院妇产科,江苏苏州215006

出　　处：《介入放射学杂志》2006年第5期264-266,共3页Journal of Interventional Radiology

摘　　要：目的探讨经子宫动脉插管灌注和栓塞治疗输卵管妊娠的可行性、安全性和疗效。方法采用改良Seldinger技术,对42例输卵管妊娠患者行超选择性子宫动脉插管造影,根据造影表现类型不同,灌注甲氨蝶呤(MTX)50～100mg,灌注后用明胶海绵颗粒栓塞子宫动脉。术前和术后观察临床症状、测血β-hCG值和测量妊娠囊大小的变化,分别于术后0.5、6、12、24、36和48h测外周血MTX浓度。结果42例中38例获得成功,4例失败改行手术或腹腔镜治疗。治愈率为90.5%(38/42)。术后血β-hCG水平下降至正常平均所需时间(8.3±2.0)d,MTX用量为50mg、75mg后36h测不出血药浓度,用量为100mg的48h后血药浓度均值为0.01μmol/L。无不良反应。结论经子宫动脉灌注和栓塞治疗输卵管妊娠方法简便、安全、有效,无明显并发症,有望为输卵管妊娠特别是合并少量出血或预防高危大出血的首选疗法。Objective To study the feasibility, safety, and efficacy of the treatment for tubal pregnancy by interventional technique of transuterine arterial catheterization perfusion and embolization. Methods Using modified Seldinger technique, 42 cases of tubal pregancy received super-selective angiography of uterine artery, followed by perfusion of 50-100 mg methotrexate （MTX） through the catheter and embolization of uterine artery with gelatin sponge. Before and after the procedure,changes of clinical symptoms, physical signs, value of β-hCG and size of pregnancy cyst of patients were studied. Concentrations of MTX in peripheral blood were studied at 0.5,6,12,24,36,48 hours after the procduce. Results 38 out of 42 cases were cured with successful rate of 90.5% （38/42）. The average time of β-hCG decreasing to normal was 8.26 ± 2.04 days. The concentration of MTX in peripheral blood with 50 mg or 75 mg dosage could not be detected at 36 hours after the proceduce but could be detected as 0.01 μmol/L at 48 hours after the procedure with a dosage of 100 mg. Conclusions It is simple, safe and efficient in performing trans-uterine artery chemo-embolization for therapy of fallopian tubal pregnancy, especially for those who complicated with manipulus bleeding and also as the first choice for prevention of high risk massive hemorrhage. （J Intervent Radiol, 2006, 15. 264-266）

关 键 词：放射学 介入性 妊娠 输卵管 栓塞 治疗性 

分 类 号：R714.22[医药卫生—妇产科学]