子宫动脉栓塞联合孕囊注射甲氨蝶呤序贯清宫术治疗瘢痕妊娠  

Uterine artery embolization combined with gestational sac injection of methotrexate for the treatment of cesarean scar pregnancy

作　　者：谭中宝[1] 毛学群[1] 王庆庆[1] 张建[1] 邹容[1] 狄镇海[1] 刘文新[1] TAN Zhongbao;MAO Xuequn;WANG Qingqing;ZHANG Jian;ZOU Rong;DI Zhenhai;LIU Wenxin(Department of Interventional Radiology,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu Province 212001,China)

机构地区：[1]江苏大学附属医院介入放射科,江苏镇江212000

出　　处：《介入放射学杂志》2020年第1期96-99,共4页Journal of Interventional Radiology

基　　金：江苏大学校科研资助项目(1293000517);镇江市科技支撑计划(社会发展)指导项目(FZ2011046)。

摘　　要：目的探讨子宫动脉栓塞(UAE)联合超声引导孕囊内注射甲氨蝶呤(MTX)在瘢痕妊娠(CSP)清宫术术前应用的有效性和安全性。方法收治住院的确诊为瘢痕妊娠的患者38例,其中接受超声引导下于孕囊内MTX注射联合UAE清宫术者16例为观察组,UAE并行MTX全身化疗清宫术者为22例为对照组。对比两组患者清宫术出血情况、住院时间、住院期间β-HCG变化情况、MTX使用剂量、β-HCG恢复时间、阴道流血时间、月经恢复时间及并发症情况。结果两组患者在剖宫产β-HCG恢复时间、术中出血量及月经恢复时间差异均无统计学意义。观察组患者在住院期间β-HCG下降速度和程度较对照组快,观察组患者局部MTX使用剂量低于对照组。对照组中2例(2/22,9.1%)在清宫术中发生大出血,1例经输血、水囊压迫治疗后好转,1例清宫术中大出血中转子宫切除。结论UAE联合孕囊注射MTX可以有效降低瘢痕妊娠大出血发生率。超声引导下局部孕囊内MTX注射对快速下降β-HCG水平有一定优势,尤适用于高β-HCG水平患者。Objective To discuss the efficacy and safety of uterine artery embolization(UAE)combined with ultrasound-guided gestational sac injection of methotrexate(MTX)before uterine curettage in treating cesarean scar pregnancy(CSP).Methods A total of 38 patients with proved CSP,who were admitted to Gynecology Department in authors’hospital,were enrolled in this study.The patients were divided into observation group(n=16,receiving UAE combined with uterine curettage by using ultrasound-guided gestational sac injection of MTX)and control group(n=22,receiving UAE and uterine curettage by using MTX systemic chemotherapy).The blood loss during uterine curettage,hospitalization days,changes inβ-HCG levels during hospitalization period,used dose of MTX,recovery time ofβ-HCG level,vaginal bleeding time,menstrual recovery time and complications were compared between the two groups.Results No statistically significant differences in the recovery time ofβ-HCG level,the blood loss during uterine curettage and the menstrual recovery time existed between the two groups.During hospitalization period,the falling speed and falling degree ofβ-HCG levels in the patients of observation group were faster and greater than those in the patients of control group.The used dose of MTX in the observation group was lower than that in the control group.Two patients(2/22,9.1%)in the control group developed massive hemorrhage during uterine curettage,one patient was improved after blood transfusion and water bag compression therapy,and the other patient had to receive hysterectomy.Conclusion Combination use of multiple interventional therapies can effectively reduce the incidence of massive bleeding in scar pregnancy.Ultrasound-guided gestational sac injection of MTX has certain advantage for rapid decrease ofβ-HCG level,which is particularly suitable for patients with highβ-HCG levels.

关 键 词：子宫动脉栓塞术 甲氨蝶呤局部注射 瘢痕妊娠 

分 类 号：R713.8[医药卫生—妇产科学]