剖宫产术后子宫切口部位妊娠治疗方法的探讨

Treatments of cesarean scar ectopic pregnancy

目的探讨剖宫产术后子宫切口妊娠治疗的方法。方法对20例子宫切口妊娠患者急诊行双侧子宫动脉超选择性插管，输注甲氨蝶呤（MTX）后，再用明胶海绵颗粒栓塞双侧子宫动脉，7～10d内再在B超引导下行刮宫术或吸宫术。同时选择18例（因各种原因未做介入治疗的患者）按传统的方法治疗作为对照组。结果19例患者均成功施行了子宫动脉化疗输注加栓塞术，7～10d内顺利行刮宫术或吸宫术，术中出血量少；仅有1例因出血较多行开腹手术，但同时保留子宫；而对照组有10例因出血多行急诊开腹手术，其中6例切除子宫。结论子宫动脉化疗输注加栓塞术为剖宫产术后子宫切口妊娠患者的保守治疗提供了安全保障，使患者避免子宫被切除，是一种安全、有效的治疗方法。

Objective To study the treatments of pregnancy located at the uterine incision after cesarean section. Methods Emergency bilateral super- selective uterine artery catheterization was per- formed in 20 patients with pregnancy located at the uterine incision after cesarean section. After infusion of methotrexate（MTX） , gelatin sponge granules were injected for embolization bilaterally, Uhrasonogra- phy - guided dilatation and curettage or uterine aspiration was carried out within 7 - 10 days afterwards. At the same time, the other 18 cesarean scar ectopic pregnancy patients without trans - uterine artery chemotherapy and embolization （ because of all kinds of causes） as control group. Results Trans - uter- ine artery chemotherapy and embolization in combination with uhrasonography -guided dilatation and curettage or uterine aspiration were successfully carried out in 19 of the 20 cases with minimal bleeding during dilatation and curettage or uterine aspiration, only one of them was carried outoperation because of ponderosus bleeding, but the uterus was remained. However the surgeries were car- ried out in 10 of control group because of ponderosus bleeding and six uteruses were removed. Conclu- sions Trans- uterine artery chemotherapy and embolizationin combination provide a safe and effective approach for the treatment of pregnancy located at the uterine incision after cesarean section.