子宫动脉甲氨蝶呤灌注及栓塞联合超声引导清宫术治疗剖宫产后瘢痕妊娠  

Transcatheter intraaterial methotrexate infusion and uterine artery embolization combined with ultrasound guided curettage for treatment of cesarean scar pregnancy

作　　者：崔艳峰[1] 朱蕻潮 黄红香[2] 徐浩[1] 魏宁[1] 张庆桥[1] 许伟[1] 

机构地区：[1]徐州医学院附属医院介入放射科,江苏徐州221002 [2]徐州医学院附属医院妇产科

出　　处：《徐州医学院学报》2015年第5期324-327,共4页Acta Academiae Medicinae Xuzhou

摘　　要：目的探讨经双侧子宫动脉甲氨蝶呤（MTX）灌注及栓塞联合超声引导清宫术治疗剖宫产后瘢痕妊娠的临床价值。方法回顾性分析17例剖宫产后瘢痕妊娠患者的临床资料，采用4—5F导管行双侧子宫动脉超选择插管，分别注入MTX及明胶海绵颗粒进行栓塞。术后3～6天行超声引导下清宫术。结果17例患者均成功行子宫动脉MTX灌注及栓塞联合超声引导下清宫术，其中包括化疗效果差及不全流产患者各2例。术中无子宫破裂、宫腔感染及大出血等并发症，术后血β-人绒毛膜促性腺激素（β-HCG）经11—42天恢复至正常水平。结论经双侧子宫动脉MTX灌注及栓塞联合超声引导清宫术治疗瘢痕妊娠安全、有效、并发症少，能保留女性子宫及生育能力。Objective To assess the application of transcatheter intraaterial methotrexate （MTX） infusion and uterine artery embolization combined with uhrasuund guided curettage for treatment of cesarean scar pregnancy. Methods Clinical data were collected from 17 patients with cesarean scar pregnancy before retrospective analysis. All patients were subject to super - selective catheterization where 4 - 5 F catheters were bilaterally inserted into the uterine artery, followed by embolization with MTX and gelatin sponge particles. Then, ultrasound guided curettage was performed three to six days after surgery. Results All patients were treated successfully, including two cases of poor chemotherapeutic responses and two cases of incomplete abortion. There were no reports about metrorrhexis, infection at the uterine cavity, hemorrhoea and other complications. Their levels of β - HCG were returned to the normal 11 - 42 days after surgery. Conclusion Transcatheter intraaterial methotrexate infusion and uterine artery embolization combined with ultrasound guided curettage is a safe and effective technique to treat cesarean scar pregnancy, which causes less complications and can retain the uterus and fertility of women.

关 键 词：瘢痕妊娠 清宫术 子宫动脉栓塞 Β-人绒毛膜促性腺激素 

分 类 号：R714.22[医药卫生—妇产科学]