介入治疗瘢痕处妊娠12例临床观察与分析  

Clinical Observation and Analysis of Interventional Treatment in the 12 Cases of Scar Pregnancy

作　　者：宁华丽 马壮[2] 

机构地区：[1]广东省东莞市石碣医院,广东东莞523960 [2]广东省东莞市厚街医院

出　　处：《中国医学创新》2014年第5期117-119,共3页Medical Innovation of China

基　　金：东莞市科技局立项项目(20131051010081)

摘　　要：目的:探讨采用双侧子宫动脉栓塞+大剂量甲氨蝶呤子宫动脉灌注治疗瘢痕处妊娠的临床疗效及安全性。方法:自2011年1月-2013年6月,采用Seldinger技术对12例孕70 d内瘢痕处妊娠患者行右股动脉穿刺,在DSA监视下,将动脉导管经股动脉选择性插入子宫动脉,将大剂量化疗药物(甲氨蝶呤100 mg/m2)直接注入双侧子宫动脉内,同时用可吸收1 mm的明胶海绵颗粒栓塞双侧子宫动脉;术后8 d内在B超指引下行首次清宫术。结果:12例患者介入治疗术后,血β-hCG均明显下降,首次清宫无一例大出血,患者平均出血量(210±50)mL;其中9例患者经一次介入治疗和一次清宫术后痊愈;2例是因为血β-hCG的值超过20 000 IU/L,所以介入治疗后下降不理想,行宫腔镜下病灶清除术;1例因出血并血β-hCG下降不理想,行第二次介入治疗。12例患者均成功保留患者子宫,平均住院时间12.5 d,术后随访3个月无明显并发症。结论:介入治疗瘢痕处妊娠防止大出血效果良好,并能够保留患者子宫,可以作为CSP的首选治疗方法,值得在临床进一步推广应用。Objective： To study the clinical efficacy and safety of bilateral uterine artery embolizatian and high dose mcthotrexate uterine artery infusion in the treatment of scarpregnaney. Method： From January 2011 to June 2013, used Seldinger in 12 cases of scar pregnancy underwent the right femoral artery puncture, under DSA surveillance, an artery catheter was inserted through the femora[ artery selective uterine artery, the high dose chemotherapy （ with 100 mg/m2 ） directly into bilateral uterine arteries, and can absorb 1 mm bilateral uterine artery embolization with gelfoam particles; within 8 days after the B ultrasound guided curettage down for the first time. Result： 12 patients after interventional treatment, serum 13 - hCG decreased significantly, for the first time in no bleeding in 1 cases, with the average amount of bleeding （ 210±50 ） mL. 9 patients with l times of interventional treatment, and 1 recovered after curettage; 2 cases because of blood 13 -hCG exceeded 20 000 IU/L, so the intervention decreased after the treatment was not ideal, hysteroscopic debridement; 1 cases of hemorrhage and blood β -hCG drop was not ideal, had second times of interventional treatment. 12 cases were successful, with preservation of the uterus, the average hospitalization time was 12.5 d, patients were followed up for 3 months without complication. Conclusion： Interventianal treatment of scar pregnancy to prevent bleeding and good effect, and can keep the patients with uterine, can be used as the preferred method of treatment of CSP, it is worth popularizing in clinic.

关 键 词：瘢痕处妊娠 介入治疗 甲氨蝶呤 绒毛膜促性腺激素 出血 

分 类 号：R714.2[医药卫生—妇产科学]