子宫动脉化疗栓塞在剖宫产切口瘢痕妊娠中的应用研究

The application of uterine artery chemoembolization in treating cesarean section scar pregnancy

目的探讨子宫动脉灌注化疗栓塞术治疗剖宫产切口瘢痕妊娠的可行性和安全性。方法 2005年6月至2010年6月在复旦大学附属妇产科医院就诊的130例剖宫产切口瘢痕妊娠患者行子宫动脉化疗栓塞术,经双侧子宫动脉各灌注甲氨蝶呤(methotrexate,MTX)100～150 mg,庆大霉素8万u,再以明胶海绵栓塞,其中23例合并子宫肌瘤患者,以PVA颗粒栓塞,术后24～72 h时行清宫术。结果子宫动脉化疗栓塞操作成功率100%。清宫术时出血12～110 ml,平均28.5 ml。无严重并发症发生。结论子宫动脉化疗栓塞配合清宫术可明显降低子宫切除和丧失生育能力的风险,是治疗剖宫产切口瘢痕妊娠安全可行的方法。

Objective To discuss the feasibility and safety of uterine artery chemoembolization in treating cesarean section scar pregnancy.Methods During the period of Jun.2005-Jun.2010,uterine artery chemoembolization was performed in 130 patients with cesarean section scar pregnancy in authors＇ hospital.Via bilateral uterine arteries 100-150 mg MTX and 80 000 u Gentamycin were infused separately,which was followed by the embolization of bilateral uterine arteries with Gelfoam.Of the total 130 patients,coexisted leiomyoma was found in 23 and embolization therapy with PVA microspheres was employed.Curettage of uterus was carried out within 24-72 hours after the procedure.Results The success rate of bilateral uterine artery chemoembolization was 100%.The blood loss during curettage procedure was 12-110 ml（mean 28.5 ml）.No serious complications occurred.Conclusion The uterine artery chemoembolization is an effective and safe treatment for cesarean section scar pregnancy.This technique can greatly avoid unnecessary uterectomy and,thus,preserve the fertility of the female patients.