剖宫产术后子宫切口瘢痕妊娠介入治疗价值探讨

Investigation of the Value of Uterine Artery Interventional Therapy in the Management of Cesarean Scar Pregnancy

目的:探讨经子宫动脉介入化疗栓塞治疗剖宫产切口瘢痕妊娠的应用价值。方法:回顾分析本院自2006年7月至2007年12月子宫动脉介入治疗的15例剖宫产切口瘢痕妊娠病例资料。结果:15例介入治疗均成功,其中8例化疗及明胶海绵栓塞后加用弹簧圈栓塞,术后阴道流血停止,孕囊明显缩小,血清人绒毛膜促性腺激素明显下降。术后清宫无大出血,病理检查示子宫瘢痕部位绒毛、蜕膜或胎盘组织,有变性、坏死。结论:经子宫动脉介入治疗剖宫产瘢痕妊娠,能有效预防和控制出血,减小清宫危险,并保留子宫,是剖宫产瘢痕妊娠安全、有效的治疗方法之一。

Objective：To investigate the value of uterine artery chemotherapy and embolization in the treatment of cesarean scar pregnancy.Methods：Fifteen cases with cesarean scar pregnancy performed with uterine artery interventional therapy were retrospectively analyzed from July,2006 to December,2007 in our hospital.Results：All cases were treated successfully by uterine artery chemotherapy and embolism.All cases were embolized with gelatin sponge after chemotherapy,and eight with spring ring additionally.Vaginal bleedings were stopped after uterine artery embolization.Gestation sacculi deflated obviously.Serum human chorionic gonadotrophin descended dramatically.There was no severe vaginal bleeding by curettage after interventional therapy.The villi,decidua,or placental tissues were observed with degeneration and necrosis by pathology.Conclusion：Uterine artery chemotherapy and embolization was proved to be a safe and useful procedure for preventing and controlling vaginal bleeding,diminishing the risk of curettage and avoiding the loss of uterus.