子宫动脉栓塞术应用于剖宫产瘢痕妊娠和宫颈妊娠的疗效与安全性  

The Efficacy and Safety of Uterine Artery Embolization for Cesarean Scar Pregnancy and Cervical Ectopic Pregnancy

作　　者：龙德来 魏振河[1] 杨华[1] 

机构地区：[1]天津市中心妇产科医院,300100

出　　处：《国际妇产科学杂志》2014年第3期307-310,共4页Journal of International Obstetrics and Gynecology

摘　　要：目的：探讨子宫动脉栓塞术（UAE）用于治疗剖宫产瘢痕妊娠（CSP）和宫颈妊娠（CEP）的疗效及安全性。方法：对2011年4月1日-2013年4月1日在天津市中心妇产科医院确诊并行UAE联合甲氨蝶呤（MTX）治疗的76例CSP患者及14例CEP患者的资料进行统计分析。结果：90例患者在行UAE后均未出现严重的不良反应和并发症，且都不需行重复性UAE或局部病灶切除术或子宫切除术。UAE术前有胎心与无胎心的CSP和CEP患者的术后失血量差异均无统计学意义（t分别为0.234和0.730，P＞0.05）；术前CSP和CEP患者的血人绒毛膜促性腺激素（hCG）值的高低与术后失血量均不存在相关性（r分别为0.063和0.293，P＞0.05）；而CSP和CEP患者UAE术后血hCG值下降明显者比下降不明显者的术后失血量明显减少（t分别为-6.683和-5.461，P=0.000）；不同类型的CSP的患者在UAE术后的失血量差异也有统计学意义，即胎囊突向浆膜面者失血量多于胎囊突向宫腔者（t=5.731，P=0.000）；UAE术后患者的主要不良反应为发热和腹痛；成功随访的70例患者于术后30-62 d都恢复了月经。结论：UAE联合MTX经子宫动脉局部灌注用于治疗CSP和CEP具有安全有效性。Objective：To assess the efficacy and safety of uterine arteries embolization （UAE） for the treatment of cesarean scar pregnancies （CSP） and cervical ectopic pregnancy （CEP）. Methods：A prospective study for case series of seventy-six women with CSP and fourteen women with CEP were accurately identified by Tianjin Central Hospital of Gynecology Obstetrics between April 1,2011 and April 1,2013. All of the patients underwent UAE combined with methotrexat （MTX）. Results：All of the patients were successfully treated without any severe adverse reactions or complications ,and did not need a repetitive uterine artery embolism or uterus resection or partial resection of the local lesions. No significant differences of blood loss were seen between whether the embryo was alive before UEA （CSP：t=0.234;CEP：t=0.730,P〉0.05）. There is no correlation between beta-human chorionic gonadotropin level before UAE and blood loss. The difference was found to be statistically significant between whether the beta-human chorionic gonadotropin level dropped obviously （CSP：t=-6.683;CEP：t=-5.461,P=0.000）, and the difference was also found significant between the different types of CSP （t=5.731,P=0.000）.The complications were mainly fever and abdominal pain; 70 patients were followed up,and all of them had recovered their normal menstruation . Conclusions：UAE with MTX appears to be a safe and effective treatment for CSP and CEP.

关 键 词：剖宫产术 瘢痕 妊娠 栓塞 治疗 

分 类 号：R719.8[医药卫生—妇产科学]