子宫动脉栓塞与甲氨蝶呤治疗不同MRI分型的剖宫产术后疤痕妊娠的疗效评价  

Uterine artery chemoembolization and systemic methotrexate in treating cesarean scar pregnancy of different MRI types

作　　者：李奎[1] 颜国辉 邹煜[1] Li Kui;Yan Guohui;Zou Yu(Department of Radiology, Women’s Hospital, School of Medicine,Zhejiang University, Hangzhou 310006, China)

机构地区：[1]浙江大学医学院附属妇产科医院放射科,杭州310006

出　　处：《中华介入放射学电子杂志》2017年第3期128-134,共7页Chinese Journal of Interventional Radiology：electronic edition

基　　金：浙江省教育厅科研基金项目(Y201534762)

摘　　要：目的:探讨剖宫产后疤痕妊娠(CSP)的MRI影像学表现及分型对其治疗的指导意义,评价甲氨蝶呤(MTX)联合刮宫及子宫动脉化疗栓塞术(UACE)联合刮宫治疗不同类型CSP的适应证、有效性及安全性。方法:回顾性分析于我院治疗且影像资料完整的CSP患者187例,其中CSP 1型57例,CSP 2型130例,根据MRI分型及治疗方式的不同将患者分为4组:A1组(CSP 1型患者行MTX联合刮宫术者)45例,B1组(CSP 1型患者行UACE联合刮宫术)12例;A2组(CSP 2型患者行MTX联合刮宫术者)40例,B2组(CSP 2型患者行UACE联合刮宫术)90例。对患者术后临床数据及随访结果进行统计分析。结果:A1、B1两组的刮宫术中出血量、术后第1天血β-h CG下降超过50%者的比例、肝功能异常率、子宫切除率、治疗成功率的差异均无统计学意义。但A1组患者的住院时间明显长于B1组,差异有统计学意义。A2组的刮宫术中出血量、住院时间、肝功能异常率、子宫切除率高于B2组,术后第1天血β-h CG下降超过50%者的比例、治疗成功率低于B2组,差异均有统计学意义。结论:MRI能够明确CSP诊断,并准确分型,对于治疗方式的选择有重要指导意义。UACE联合刮宫治疗CSP的效果优于MTX联合刮宫术,尤其是对于CSP 2型患者更能降低子宫切除率,保留生育功能,可作为CSP 2型患者的首选治疗方式。Objective:To study various types of MRI imagings of cesarean scar pregnancy(CSP),and to evaluate their significance in clinical application.Also,the indications,efficacy and safety of methotrexate(MTX)combined with uterine curettage and uterine artery chemoembolization(UACE)combined with curettage in the treatment of different types of CSP were as well studied.Methods:Clinical data of187patients with CSP treated in our hospital were retrospectively analyzed.They were divided into four groups according to different MRI types and treatments:Group A1(CSPI patients treated by MTX combined with curettage),45patients;group B1(CSPI patients treated by UACE combined with curettage),12patients;group A2(CSPII patients treated by MTX combined with curettage),40patients;and group B2(CSPII patients treated by UACE combined curettage),90patients.Their relative clinical data and follow-up results were statistically analyzed.Results:The blood loss during curettage showed no difference in both group A1and group B1,while the number of patients withβ-hCG decreased by more than50%in the first day after curettage,and abnormal liver function rate,hysterectomy rate and treatment success rate all showed no significant difference.However,hospital stay in group A1was much longer than in group B1,with significant difference.Group A2and group B2were seen a significant difference in blood loss during curettage,hospital stay,abnormal liver function rate,hysterectomy rate,decreasedβ-hCG decreased in the first day after curettage and treatment success rate.Conclusion:MRI can not only diagnose CSP,but also can confirm its different types,thus,it has an important clinical significance for the treatment of CSP.UACE combined with curettage had better effect than MTX combined with curettage in the treatment of CSP patients,especially for CSPII patients,and it should be the first choice for the patients with CSPII.

关 键 词：子宫动脉栓塞术 甲氨蝶呤 疤痕妊娠 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R714.22[医药卫生—诊断学]