低流量低剂量甲氨蝶呤动脉灌注栓塞术在终止子宫瘢痕妊娠的应用  

The Clinical Application Value of Intra-Arterial Infusion of Low-Flow And Low-Dose Methotrexate Plus Embolization in Termination of Caesarean Scar Pregnancy

作　　者：刘名利 刘志华 谭莹 邝明涛 符国平 岳振东[4] LIU Mingli LIU Zhihua TAN Ying et al(Department of Radiology, Maternal and Child Health Care Hospital of Xiangtan County, Hunan Province 411228, P. R. China)

机构地区：[1]湘潭县妇幼保健院放射科,湘潭411228 [2]湘潭县人民医院放射科 [3]湘潭县妇幼保健院妇科,湘潭411228 [4]首都医科大学附属肿瘤医院北京世纪坛医院介入科

出　　处：《临床放射学杂志》2016年第11期1754-1757,共4页Journal of Clinical Radiology

摘　　要：目的 探讨低流量低剂量甲氨蝶呤（MTX）动脉灌注栓塞术在终止剖宫产术后子宫瘢痕妊娠（CSP）中的应用价值。方法 对诊断明确的83例CSP患者行DSA血管造影、低流量低剂量MTX子宫动脉灌注加栓塞术,术后在宫腔镜下行清宫术,对疗效及出血量及月经恢复时间进行分析。结果 83例CSP的患者行低流量动脉灌注加栓塞术后,均在3~5天内行清宫术,恢复良好,术中出血量均〈20 ml,平均出血量约（11.3±2.14）ml,清宫术前血β-HCG下降明显,术后β-HCG平均恢复正常时间为（22±3.86）天,术后平均月经恢复时间为（52±6.53）天。结论 低流量低剂量MTX动脉灌注栓塞术在终止CSP应用中,能明显减少MTX用量,血β-HCG值下降明显,恢复正常值时间缩短,减少清宫术中组织损伤及术中出血,月经恢复时间缩短,是一种安全、有效的治疗方法。Objective To discuss the clinical application value of complete curettage of the uterine cavity combined with intra-arterial infusion of low-flow and low-dose methotrexate （MTX） plus embolization in termination of caesarean scar pregnancy（ CSP ）, the prevention of bleeding, and the reduction of MAT dosage and MTX toxic and side effects. Methods Digital subtraction angiography （DSA） was performed in diagnosed uterine scar pregnancy cases. Hysteroscopic complete curettage of the uterine cavity was performed after intra-arterial infusion of low-flow and low-dose MTX with embolization. The therapeutic effects and quantity of hemorrhage and postoperative menstruation recovery time were analyzed. Results Complete curettage of the uterine cavity was performed 3 to 5 days after intra-arterial infusion of low-flow and low- dose MTX with embolization in 83 patients with caesarean scar pregnancy. The prognosis was good with a postoperative quantity of hemorrhage of below 20ml of blood, an average quantity of hemorrhage of about （ 11.3 ±2.14）ml of blood, obvious reductions of blood β-HCG before complete curettage of uterine cavity, postoperative recovery time of 22 ± 3.86 days for β-HCG and an average postoperative menstruation recovery time of 52± 6.52 days in all patients. Conclusion Under the precondition of successful super-selective uterine artery catheterization, the application of embolization with low-flow and low-dosage MTX intra-arterial infusion in the termination of CSP reduces MTX dosage and blood [3-HCG value significantly, cuts recovery time, reduces tissue damages and intra-operative bleeding in complete curettage of the uterine cavity and shortens menstruation recovery time, being a safe and effective therapeutic method.

关 键 词：瘢痕妊娠 动脉灌注 子宫动脉栓塞术 清宫术 甲氨蝶呤 

分 类 号：R714.22[医药卫生—妇产科学]