子宫动脉化疗栓塞术治疗子宫瘢痕妊娠  

Uterine Artery Chemoembolism for the Treatment of Cesarean Scar Pregnancy

作　　者：陶智慧[1] 李楠[2] 梅松原[1] 宁志方[1] 马勇[1] 巩芳伟 

机构地区：[1]中航工业哈尔滨二四二医院,黑龙江哈尔滨150066 [2]黑龙江省医院,黑龙江哈尔滨150001

出　　处：《现代生物医学进展》2013年第34期6726-6728,6752,共4页Progress in Modern Biomedicine

基　　金：黑龙江省卫生厅科研课题(2011-507)

摘　　要：目的：本文采用双侧子宫动脉化疗栓塞术治疗子宫瘢痕妊娠，通过讨论其临床疗效、术后并发症及愈后情况，旨在为临床治疗子宫瘢痕妊娠提供一种安全、有效、合理的治疗方法。方法：对27例确诊为子宫瘢痕妊娠的患者采用seldinger技术穿刺股动脉，在DSA监视下，分别超选择双侧子宫动脉，各灌注甲氨蝶呤20mg，再注入明胶海绵颗粒栓塞至子宫动脉完全闭塞。3～5天后，在硬膜外麻醉及彩超监视下行宫腔镜病灶切除术。术后随访3～6个月，观察月经恢复情况。结果：本组所有患者均一次性栓塞治疗成功，造影显示子宫动脉闭塞良好，患者阴道不规则出血迅速停止。宫腔镜病灶切除术中出血极少，无子宫破裂、大出血等严重并发症发生。术后5～10天，所有患者血hCG均恢复至正常水平；随访3～6个月，所有患者月经均恢复正常。结论：子宫动脉化疗栓塞术治疗子宫瘢痕妊娠损伤小、安全有效，可以减少子宫破裂、大出血等严重并发症发生，保留患者子宫及附件的正常解剖及生理功能，尤其适用于有生育要求的妇女，适合临床广泛应用。Objective： To provide a kind of safe, effective and reasonable clinical treatment for cesarean scar preg- nancy, by eval- uating the clinical effect, complications and prognosis of the technique of uterine artery chemoembolism. Methods： Via surper-selected bilateral uterine arteries, 20mg MTX was performed in 27 patients who were diagnosed as cesarean scar pregnancy by seldinger tech- nique under DSA, and then Gelfoam sponge particles were followed to embolize bilateral uterine arteries until they were blocked. After 3 to 5 days, lesion resection was carried out under the hysteroscopy through epiduralanaethesia and ultrasound. 3 to 6 months later, the pa- tients＇ condition of the menstruations was observed. Results： All cases were treated successfully at one time. Bilateral uterine arteries were blocked well in radiography. Irregular vaginal bleeding stopped quickly after interventional therapy. In hysteroscopy lesion resec- tion, they haemorrhaged slightly, and no serious complications of the rupture ofuters and massive haemorrhage occured. Atter 5 to 10 days, the level of hCG in blood of all cases recovered to normal limits. Follow-up was accessed 3 to 6 months, the menstruations of all cases were in normal limits. Conclusions： Uterine artery chemoembolism is a less damage, effective and safe method for cesarean scar pregnancy. This technique is suitable to clinical application widely because it can completely preserve the normal anatomy and physiological fimc- tion of uterine and ovary, being suitable for the women who have fertility requirements particularly.

关 键 词：子宫动脉 化疗栓塞 介入治疗 子宫瘢痕妊娠 

分 类 号：R714[医药卫生—妇产科学]