子宫动脉栓塞联合刮宫术治疗子宫切口妊娠的临床应用

Uterina Arterial Embolism Combined with Dilatation and Curettage Used for Treatment of Gestation in Uterina Incision

目的探讨超选择性子宫动脉栓塞联合刮宫术治疗子宫切口妊娠的疗效及并发症。资料与方法18例切口妊娠患者常规行超选择双侧子宫动脉栓塞术后8～24h实施刮宫术,刮出组织均送病理检查,估计出血量。栓塞材料选用单纯明胶海绵颗粒,大小为0.5mm×0.5mm×0.5mm和1.0mm×1.0mm×1.0mm。结果18例患者中17例成功实施双侧子宫动脉超选择插管及栓塞,栓塞成功率为94.4%(17/18);另1例右侧单角子宫畸形,子宫动脉栓塞成功,左侧子宫动脉缺如,插管失败。DSA造影示子宫腔内均未见妊娠囊,子宫峡部可见妊娠囊血管征。18例患者顺利刮宫,17例出血在10～40ml,1例出血约450ml,出血明显减少,有效率100%(18/18)。刮出组织病理切片均见胚胎绒毛、瘢痕组织。结论超选择性双侧子宫动脉栓塞联合刮宫术是一种治疗子宫切口妊娠安全、有效、并发症低的方法。

Objective To investigate the therapeutic effect and complications of ultraselective uterina arterial emboli＇sm combined with dilatation and curettage used for the treatment of gestation in the uterina incision. Materials and Methods Eighteen patients with clinically confirmed gestation in the uterina incision were enrolled in our study. All the patients underwent ultraselective uterina arterial embolism, then 8 -24 hours later underwent subsequent dilatation and curettage The granula of spongia gelatinosa with the size of 0.5× 0.5×0.5 mm or 1.0×1.0 ×1.0 mm was used for uterina arterial embolism. The postoperative pathologic tissues obtained by dilatation and curettage were used to estimate the bleeding volume. Results Ultraselective embolism of hibateral uterine artery was performed successfully in 17 patients （ 94.4% ）. Digital subtraction angiography showed no gestation sac in the cavitas uteri hut in the isthmus uteri. One case of embolism was aborted owing to right unicornuate uterus. After the embolism, all the patients underwent dilatation and curettage successfully. The specimen were demonstrated as cyema villus and cicatricial tissue. The bleeding volume were 10 -40 ml in 17 patients and 450 ml in one patient, and the loss decreased greatly in 18 patients （ 100% ）. Conclusion Uhraselective uterina arterial embolism combined with dilatation and curettage could be an effective method with minor complications for the treatment of gestation in the uterina incision.