子宫动脉化疗栓塞术治疗剖宫产瘢痕妊娠的临床分析  

Clinical Analysis of Uterine Artery Chemotherapy Embolization in Treatment of Cesarean Section Scar Pregnancy

作　　者：姚凤球[1] 陈素玉[1] 高婷[1] 王群华[1] 

机构地区：[1]安徽医科大学附属安徽省立医院妇产科,安徽合肥230001

出　　处：《中国伤残医学》2014年第9期33-35,共3页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的：探讨子宫动脉化疗栓塞术（ uterine artery chemotherapy embolization ，UACE）治疗剖宫产瘢痕部位妊娠（ cesare-an section scar pregnancy ，CSP）的临床疗效。方法：回顾性分析2008年9月～2012年2月安徽省立医院医院收治的17例行子宫动脉灌注化疗加栓塞术治疗子宫瘢痕处妊娠患者的临床资料。结果：17例患者中，7例因瘢痕妊娠贸然清宫术中发生大出血而采用急诊UACE，所有发生大出血患者于UACE术后均停止出血，其中1例在术后第4天妊娠组织自行脱落，复查彩超子宫下段异常回声团消失，彩色多普勒血流信号消失，未予吸宫出院；8例患者采用UACE术后3天在B超监测下行吸宫术，吸宫术中均未出现大出血，自行脱落组织及吸宫组织均送病理，病理可见大量坏死的绒毛组织；4例患者UACE术后配合米非司酮保守治疗3天，其中3例血清人绒毛膜促性腺激素β亚单位（β-HCG）下降明显，疤痕处包块缩小，未清宫出院，1例患者术后血β-HCG下降缓慢，且包块突向子宫浆膜层，UACE术后第7天行子宫疤痕部位局部切除术，术后恢复良好；另4例在吸宫术中已见绒毛组织的患者，UACE术后血β-HCG下降明显，疤痕处包块缩小，未再给予米非司酮及吸宫出院，术后恢复良好。所有患者1月后复查β-HCG均完全降至正常。结论：子宫动脉灌注化疗加栓塞术治疗CSP相对微创、有效，尤其适用于CSP患者大出血的紧急治疗。Objective：To investigate the clinical value of uterine artery chemotherapy embolization （ UACE） in treatment of cesarean section scar pregnancy .Methods：The clinical data of 17 CSP patients before and after bilateral UACE in Anhui Medical University from June 2008 to February 2012 were analyzed retrospectively .Results：Among 17 patients,massive hemorrhage occurred in 7 patients because of uterine curettage rashly , then emergent UACE was adopted , All the patients with massive hemorrhage stopped bleeding after UACE , The pregnancy tissue of 1 case fell off in the fourth day , the abnormal echo mass and blooding signals disappeared in color Doppler and the pa -tient was discharged without curettage;8 patients underwent uterine curettage after 3 days under type B ultrasound , massive hemorrhage didn＆#39;t occur in the patients during uterine curettage , the necrotic villus was found in the tissue from curettage and autotomy by pathologic examination.4 patients received conservative treatment with mifepristone three days after UACE , 3 patients were discharged without curet-tage because of progressive decline β-HCG and decreasing masses in the scar , 1 patient had enlarged masses in the scar and dissatisfac-tory β-HCG level at 7 days after operation , local resection was performed , the healing condition was good .4 patients with massive hem-orrhage and villus found by naked eye during uterine curettage were discharged without mifepristone and curettage because of progressive decline β-HCG and decreasing masses in the scar .All the patients were reexamined after one month, and the levels ofβ -HCG of all the patients decreased to normal levels .Conclusion： UACE is a minimally invasive , effective method for treatment of CSP , especially UACE can be used for emergent treatment of massive hemorrhage of CSP patients during uterine curettage .

关 键 词：剖宫产瘢痕部位妊娠 子宫动脉 子宫动脉化疗栓塞术 

分 类 号：R714.2[医药卫生—妇产科学]