子宫动脉化疗栓塞术联合宫、腹腔镜治疗剖宫产瘢痕妊娠18例分析  

Uterine Artery Chemo-Embolization Combined with Hysteroscopy and Laparoscopy in Treatment of Cesarean Scar Pregnancy:a Retrospective Analysis of 18 Cases

作　　者：夏一丹[1] 梅立[1] 谢兰[1] 胡平[1] 

机构地区：[1]四川省医学科学院四川省人民医院,四川成都610072

出　　处：《实用妇产科杂志》2014年第6期472-475,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的：探讨子宫动脉化疗栓塞术（UACE）联合宫、腹腔镜在剖宫产瘢痕妊娠（CSP）治疗中的安全性和有效性。方法：回顾性分析我院2011年1月至2013年12月收治的18例CSP患者，先行选择性双侧子宫动脉插管造影，注入甲氨蝶呤（MTX）和明胶海绵颗粒栓塞后3—5天内，依据超声检查痛灶距浆膜层厚度〈0．2cm的CSP患者行宫、腹腔镜手术切除妊娠病灶。结果：①18例患者均顺利完成UACE和腔镜手术，无严重并发症及副反应发生。UACE持续时间平均约25分钟。血β—HCG由UACE前的平均17806．58±11714．36U／L降至做腔镜手术前的989．49±164．74U／L。②宫、腹腔镜手术持续时间50—110分钟，术中出血量50～150ml。无中转开腹。血β-HCG于术后3～5天降至150U／L以下出院。③术后28～45天恢复月经。结论：UACE联合宫、腹腔镜治疗CSP安全、疗效满意，尽可能地保留患者生育功能，是可为患者接受的治疗方法。Objective：To discuss the safety and feasibility of the uterine artery chemo-embolization （UACE） combined with hysteroscopy and laparoscopy in treatment of cesarean scar pregnancy（CSP）. Methods：The clinical data of 18 patients with CSP who underwent the UACE with MTX and gelfoam particles ,in Sichuan Provincial People＇s Hospital from January 2011 to December 2013 were retrospectively analyzed. Resection of pregnancy lesion by hysteroscopy and laparoscopy was carried out 3 -5 d after UACE when the thickness of the lesions to serous membrane were 〈0.2 cm under ultrasound. Results：（1）UACE and surgery was successful in all the patients,without any serious complication. The duration of UACE was 25 minutes in average. Blood beta HCG level in average decreased from 17806.58 ±11714.36 U/L to 989.49 ±164.74 U/L before hysteroscopy and laparoscopy. （2）The duration of hysteroscopy and laparoscopy ranged between 50 and 110 min, and the intraoperative blood loss ranged between 50 to 150 ml, without transition to laparotomy. Postoperative blood beta HCG decreased to less than 150 U/L within 3 -5 days. （3）Menstruation restored in 28 to 45 days. Conclusions： UACE combined with hysteroscopy and laparoscopy in treatment of CSP was safe and effective,which can avoid uterectomy and preserve the fertility as far as possible and might become one of the appropriate choice for CSP patients.

关 键 词：剖宫产瘢痕妊娠 宫腔镜术 腹腔镜术 子宫动脉栓塞 甲氨蝶呤 

分 类 号：R714.22[医药卫生—妇产科学]