子宫动脉栓塞联合灌注化疗及宫颈搔刮治疗宫颈妊娠18例临床分析

Treatment for cervical pregnancy:uterine artery embolization(UAE) followed by dilation and curettage(D&C)

目的总结经皮动脉灌注氨甲喋呤（MTX）化疗联合子宫动脉栓塞（UAE）及宫颈搔刮治疗宫颈妊娠临床效果及以后妊娠的结局。方法对2004年5月至2010年12月在我院行UAE并宫颈搔刮的18例宫颈妊娠患者进行回顾性分析及随访。结果 18例宫颈妊娠患者中,有6例活动性阴道出血者行急诊UAE后立即止血。另外12例无活动性出血者择期行UAE。所有患者在UAE后行宫颈搔刮,出血5~10 ml。所有患者均治愈并保留生育功能,无严重并发症。18例患者中,在UAE后自然受孕3例,有1例自然流产,有1例中孕13周人流,1例孕足月顺产,无母婴并发症。结论动脉灌注MTX化疗联合UAE加宫颈搔刮是治疗活动性、危及生命大出血的宫颈妊娠患者的微创方法,能保留生育功能。

Objective To analyze and summarize clinical effect and outcome of consequent pregnancy of transcatheter intraarterial methotrexate infusion combined with uterine artery embolization（UAE） followed by dilation and curettage as a treatment for cervical pregnancy.Methods The clinical data of 18 patients with cervical ectopic pregnancy who were treated May 2004 to December 2010 were retrospectively reviewed and followed-up.Results Among 18 cases with cervical pregnancy,6 cases with active vaginal bleeding underwent emergency UAE,and active bleeding can be controlled immediately;the other 12 cases of no active bleeding underwent elective UAE.After UAE and DC,all the patients were cured succesfully with 5~10 ml minimal blood loss and preserve their fertility.No patients developed severe complications from UAE.Of 18 women,three achieved another pregnancy： one miscarriages,one took vacuum extraction for artificial abortion at 13 week,one was Full-term pregnancy with live birth and no obvious maternal-fetal complications related to treatment occurred.Conclusion Transcatheter intraarterial methotrexate infusion combined with uterine artery embolization followed by dilation and curettage is an option for minimally invasive intervention in the treatment of cervical pregnancy,which can manage the active,life-threaten vaginal bleeding with preservation of fertility.