子宫动脉灌注甲氨蝶呤联合子宫动脉栓塞术治疗剖宫产瘢痕妊娠的效果分析  

Effect analysis of intra-arterial infusion of methotrexate combined with uterine artery embolization in the treatment of cesarean scar pregnancy

作　　者：张新炎 刘本波[2] ZHANG Xin-yan;LIU Ben-bo(Interventional Department,Weihai Second Municipal Hospital Affiliated to Qingdao University,Weihai 264200,China)

机构地区：[1]青岛大学附属威海市立第二医院介入科,264200 [2]青岛大学附属威海市立第二医院医学影像科,264200

出　　处：《中国实用医药》2022年第21期63-65,共3页China Practical Medicine

摘　　要：目的探究子宫动脉灌注甲氨蝶呤(MTX)联合子宫动脉栓塞术(UAE)治疗剖宫产瘢痕妊娠(CSP)的临床效果。方法回顾性分析15例CSP患者的临床资料,所有患者均实施子宫动脉灌注MTX联合UAE治疗,术后24~48 h行超声引导监测下清宫术。观察15例患者子宫动脉造影结果、治疗结果及并发症发生情况。结果CSP中,Ⅱ型3例,Ⅲ型12例。子宫动脉造影结果显示,8例患者呈弥漫性子宫峡部染色增强,供血血管增多增粗杂乱;6例患者的孕囊表现为肿块样增强;1例患者观察到CSP处造影剂外渗;1例患者可见卵巢供血来源于同侧的子宫动脉的卵巢支,可见卵巢显影明显;15例患者技术成功率为100%(15/15),临床成功率为93.3%(14/15)。15例患者均未出现子宫内感染,住院时间7~10 d,均未进行输血治疗,均保留了子宫的完整性,且在2个月内恢复正常月经。结论子宫动脉灌注MTX联合UAE治疗CSP疗效显著,可有效控制出血量,并保留子宫的完整性。Objective To discuss the clinical effect of intra-arterial infusion of methotrexate(MTX)combined with uterine artery embolization(UAE)in the treatment of cesarean scar pregnancy(CSP).Methods The clinical data of 15 CSP patients were retrospectively analyzed,and all patients were treated with intra-arterial infusion of MTX combined with UAE,and ultrasound-guided uterine curettage was performed at 24-48 h after surgery.The results of uterine arteriography,treatment results and occurrence of complications in 15 patients were observed.Results Among the CSP patients,there were 3 cases of typeⅡand 12 cases of typeⅢ.Uterine arteriography results:8 patients showed diffuse isthmus staining enhancement with increased,thickened and disordered blood supply vessels;6 patients showed mass-like enhancement of the gestational sac;extravasation of contrast medium at the CSP was observed in 1 patient;1 patient showed ovarian blood supply from the ovarian branch of the ipsilateral uterine artery,and the ovary was seen to be significantly visualized.The technical success rate was 100%in 15 patients(15/15),and the clinical success rate was 93.3%(14/15).None of the 15 patients developed intrauterine infections,had a hospital stay of 7-10 d,were not treated with blood transfusion,retained the integrity of the uterus,and resumed normal menstruation within 2 months.Conclusion Intra-arterial infusion of MTX combined with UAE is highly effective in the treatment of CSP,and can effectively control blood loss and preserve the integrity of the uterus.

关 键 词：剖宫产瘢痕妊娠 子宫动脉灌注化疗 子宫动脉栓塞术 磁共振成像 

分 类 号：R714.22[医药卫生—妇产科学]