胎盘植入介入治疗12例临床分析

Interventional Therapy of Placental Implantation:Clinical Analysis of 12 Cases

目的探讨胎盘植入介入治疗的方法、机制、栓塞剂及栓塞术后的清宫手术时间。方法 12例胎盘植入患者采用右股动脉穿刺插管,将导管超选择性插入左子宫动脉,注入MTX 50mg后用1mm3的明胶海绵颗粒行左子宫动脉栓塞;同法处理右子宫动脉。栓塞术后第8天在B超指引下行清宫术。结果 12例患者术后第8天行清宫术,均一次性将植入的胎盘组织清除干净;清除组织病理检查为胎盘植入、胎盘部分机化;栓塞术后复查血常规、肝肾功能未见异常。结论胎盘植入介入治疗术后第8天应在B超指引下及时行清宫术,胎盘植入介入治疗具有微创、止血迅速彻底、可保留子宫、保留生育功能的优点。

Objective To explore interventional therapeutic method of placental implantation. Methods Placent implantation in 12 cases was carried out by super-selective uterine artery embolization （UAE）.The procedure was performed via the right common femoral artery approach to the left uterine arteries, injection of 50rag methotrexate （MTX） and an absorbable lmm3 gelatin sponge, and the same to the right uterine artery. Then, uhrasound-guided dilation and curettage（D＆C）of uterus was carried out 8 days after UAE. Results The implanted placental tissue was curetted completely just one time for all cases. The histopathological tests showed placental implantation and placental myofibrosis, and the examination of blood rnutine and the tests of hepatic and renal fimctions were normal. Conclusion Interventional therapy of placental implantation is microinvasive and complete and rapid hemostasis, capable of reservation uterus.