子宫动脉MTX灌注+栓塞联合宫腔镜下清宫术治疗子宫疤痕妊娠

Percutaneous uterine arterial chemoembolization and hysteroscopic curettage in the treatment of postpartum hemorrhage from uterine scar

目的探讨经子宫动脉MTX灌注＋栓塞联合宫腔镜下清宫术治疗子宫疤痕妊娠的临床应用价值。方法自2010年1月～2012年11月，我院剖宫产后子宫疤痕妊娠患者9例，行双侧子宫动脉超选择性插管，缓慢灌注氨甲喋呤（MTX）后用明胶海绵颗粒（直径710～2100um）及条栓塞双侧子宫动脉，3～7d内在宫腔镜下行清宫术，观察术中出血量及术后疗效。结果9例患者均成功施行了子宫动脉MTX灌注＋栓塞联合官腔镜下清官术，术中出血量约10～40ml，术后复查血β-HCG，14～43d降至正常，住院时间平均（9.24±2.4）d，无子宫穿孔、官腔感染及粘连等并发症。结论子宫动脉MTX灌注＋栓塞联合宫腔镜下清官术治疗子宫疤痕妊娠，可有效控制出血量、并发症少、住院时间短，是一种安全、有效的治疗方法。

Objective To evaluate percutaneous uterine artery methotrexate infusion and embolization in the treatment of postpartum hemorrhage from the uterine scar after cesarean section. Methods From January 2010 through November 2012, 9 patients with postpartum hemorrhage from uterine scar after cesarean section underwent bilateral superseleetive uterine artery chemoembolization with infusion of methotrexate and gelfoam. Hysteroscopic uterine curettage was performed within 3 to 7 days to monitor any bleeding and treatment response. Results The procedure was successful in all patients with 10-40 ml of intrauterine bleeding. Embryonic villi and fibrous tissues were found in the curettage specimens. The serum β -HCG returned to normal at 14 to 43 days after the procedure. The average duration of hospitalization was 9.2 ± 2.4 days. The myometrium and endometrial cavity appeared normal on follow-up Doppler ultrasound. There were no complications including uterine rupture, endometritis, or adhesions. Conclusions Uterine artery methotrexate infusion and embolization followed by hysteroscopic curettage is a safe and effective treatment for postpartum hemorrhage from caesarian section-induced uterine scar with less bleeding, fewer complications and shorter hospitalization time compared to hysterectomy.