经子宫动脉化疗栓塞治疗子宫肌瘤合并输卵管妊娠

Transcatherter uterine embolization to treat tubal pregnancy combined uterine myoma

目的探讨经子宫动脉化疗栓塞治疗输卵管妊娠合并子宫肌瘤。方法对18例子宫肌瘤合并输卵管妊娠患者行超选择子宫动脉造影,经导管向子宫动脉灌注化疗药甲氨喋呤(MTX)及氟尿嘧啶(5-FU)后,明胶海绵颗粒或聚乙烯醇颗粒(PVA)混合平阳霉素栓塞子宫动脉。术后1周、1个月、3个月、6个月、9个月随访临床症状、体征变化,B超和MRI测子宫及肌瘤大小、体积变化,血β人绒毛膜促性腺激素(β-hCG)水平及盆腔包块变化情况。结果18例中17例获得成功,成功率94.5%,全部患者血β-hCG值6周后可降至正常,12例月经量过多中8例首次月经量被控制。16例月经量恢复正常周期。栓塞后6个月子宫肌瘤体积平均缩小44.5%,9个月肌瘤体积平均缩小55.6%。结论经子宫动脉介入治疗输卵管妊娠合并子宫肌瘤创伤小、成功率高,能有效制止内出血,扩大了保守治疗的适应证。

Objective To investigate treatment of uterine arterial chemoembolization for tubal pregnancy combined uterine myoma. Methods Using Seldinger＇ s method, 18 cases of ectopic pregnancy and uterine fibroids received superselective angiography in uterine artery and perfusing MTX（ and）5 -Fu,then embolizing uterine artery with gelfoam particles or PVA fixed PLE. There for all patients were followed - up for 1 w -9moths after uterine artery embolization to observe the improvement about symptoms ,the serum β - HCG ,the change of pelvic mass ,uterine myoma and uterine volume monitored with US or MRI, Results 17cases were successed. The success rate was98%. The time of the serumβ - HCG postoperation reaching to normal was within 6weeks. 8cases in 12cases Menstruation overage could be controled at first menstruation after operation. 16case menstruation returned to normal. The average volume of myoma decreased 44.5% in 6 months,55.6% in 9 months after proceduce. Conclusion Transuterinal artery interventional therapy for tubal pregnancy combined uterine myoma is safe and efficient and expand the indications of conservative treatment.