输卵管妊娠血管内介入治疗的临床应用  

Clinical application of interventional therapy for tubal pregnancy

作　　者：孔铭新[1] 郝刚[1] 李伟[1] 胡宗华[1] 宋剑[1] 

机构地区：[1]山东潍坊市人民医院介入放射科,山东潍坊261041

出　　处：《中国介入影像与治疗学》2008年第6期453-456,共4页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的探讨输卵管妊娠血管内介入治疗的临床价值和适应证的选择。方法30例输卵管妊娠患者,左侧12例,右侧17例,子宫峡部瘢痕妊娠1例,未破裂26例,有出血倾向4例,血β-HCG均高于正常值(51IU/L),B超均探及不均质软组织团块,孕囊大小平均2.80cm×2.16cm。采用Seldinger技术,超选择性患侧子宫动脉插管造影,经导管注入氨甲蝶呤(MTX)和5氟尿嘧啶(5-Fu)后,用明胶海绵颗粒栓塞子宫动脉。术后定期检测血清β-HCG,盆腔B超,3个月后行输卵管造影,明确输卵管通畅与否。结果子宫动脉输卵管支增粗100%(30例),宫旁类圆形绒毛血管染色占90%(27例)。介入手术全部成功,术后终止妊娠28例,治愈率93.33%,血β-HCG下降至正常平均时间(16.5±8.6)天,月经恢复正常平均时间(33.6±8.9)天;2例失败患者术前血β-HCG均高于9000IU/L,均有宫外孕手术史,患侧子宫动脉造影见卵巢动脉参与供血,7例有生育要求者3个月后行子宫输卵管碘油造影(HSG)检查通畅率100%,2例宫腔内怀孕。结论血管内介入治疗输卵管妊娠能终止妊娠,预防控制出血,保存患者的生育能力,扩大保守治疗的适应证。盆腔手术史、血β-HCG水平高(>9000IU/L)对治疗效果有一定影响,选择治疗时要慎重。Objective To study the clinical value of transuterinal artery interventional therapy in tubal pregnancy and the indication of conservative treatment. Methods Thirty cases with tubal pregnancy diagnosed by clinical methods and ultra sonography （US） were involved in the study. Among all the cases, thegestational sac of 12 cases located in the left fallopi an tubes, those of 17 cases located in right fallopian tubes and one case was isthmus uteri scar pregnancy. By using Seldinger＇s method, 30 cases of tubal pregnancy received superselective angiography of uterine artery, followed by arterial perfusion of methotrexate （MTX） and 5-fluorouracil （5 Fu） through the catheter and embolization of uterine artery with gelfoam partical. The serum 13 HCG and size of ectopic pregnancy mass were regularly monitored postoperatively. Results Uterine artery angiography showed enlarged uterine artery in all patients and vasculatrity pregnancy mass in 27 patients. Pregnant process stopped in 28 cases, success rate was 93.33%. The mean time of serum {3 HCG returning normal level was （16.5±8.6） days and menstruation returned to normal level within （33.6±8.9） days after operation. The failed 2 ca ses both operated and their serum level of 13-HCG was 9000 IU/L higher. The ovarian artery Was appeared the feeding ar tery of gestational sac after angiography. Seven cases desiring pregnancy underwent hysterosalpingograghy （HSG） after 3 months, and none appeared obstructive finding. Conclusion The treatment of tubal pregnancy by interventional technique can effectively stop pregnancy and control internal hemorrhage. It has been proven harmless to reproductive organs, and will expect to preserve fertility. Though it expands the indications of conservative treatment, the patients with high level of serum β-HCG and pelvic operation are careful to choose this technique.

关 键 词：放射学 介入性 子宫动脉 氨甲蝶呤 妊娠 输卵管 栓塞 治疗性 

分 类 号：R714.22[医药卫生—妇产科学]