经子宫动脉介入治疗输卵管妊娠27例

Treatment of tubal pregnancy by intervening in the arteria uterine:a report of 27 cases

目的:探讨选择性子宫动脉插管化疗栓塞治疗输卵管妊娠的临床疗效及相关因素。方法:采用改良Seldinger技术,对27例输卵管妊娠患者进行子宫动脉造影,经导管向患侧子宫动脉内灌注甲氨蝶呤(1例加注氟尿嘧啶),并用明胶海绵颗粒栓塞子宫动脉。术后观察临床症状、体征、血人绒毛膜促性腺激素、盆腔包块情况及腹腔积液吸收情况。结果:27例子宫动脉插管均成功,26例治愈,1例无效,治愈率96.3%,无并发症发生。其中4例术后3～10个月分别获得宫内妊娠并生育健康婴儿。结论:经子宫动脉介入治疗输卵管妊娠创伤小,治愈率高,能有效预防控制腹腔内出血,保留输卵管的完整性,是保留生育能力而治愈输卵管妊娠的有效方法。

Objective ：To explore the clinical effect of selective arteria uterine cannula chemotherapy embolism an tubal pregnancy. Methods：Twenty-seven eases of tubal pregnancy were performed arteria uterine visualization with advanced Seldinger technique. The affected arteria uterine was injected methotrexate （ one case was injected Fluorouracil ） through a catheter and filled with gel foam embolism. The clinical symptoms and signs, serum human chorionic gonadotropin, pelvic hemataoeele changes and absorption of pelvic hydrops were observed after the surgery. Results：The arteria uterine cannula was successful in all the 27 cases. Twenty-six of them were cured and 1 failed. The cure rate was 96.3%. No complication occurred. Four patients had healthy babies 3 - 10 months after the surgery. Conclnsions：The new method has the advantages of small wounds and a higher cure rate, which may effectively prevent intraperitonea bleeding,keep the integrity of the arteria uterine and thus retains the fertility.