子宫动脉灌注化疗加栓塞术治疗疤痕部位妊娠的临床应用

Clinical application of infusion chemotherapy via uterine artery combined with embolotherapy in treatment of scar pregnancy

目的:探讨诊治剖宫产术后子宫疤痕妊娠及出血的有效方法。方法:在西门子AirU DSA数字血管减影设备的引导下对11例子宫疤痕妊娠患者行子宫动脉灌注甲氨蝶呤加栓塞术的疗效观察及临床分析。结果:11例子宫疤痕妊娠伴出血的患者中8例介入术后B超下行清宫术,愈合良好;3例介入术后保守治疗,其中2例愈合良好,1例2个月后疤痕部位仍有较小团块及阴道内间断性少量出血,行子宫疤痕部位局部切除术,术后愈合良好。所有治疗患者均未出现大出血、穿孔现象,术后1个半月内β-HCG基本恢复正常,2～5个月月经恢复正常,6个月内测卵巢功能无异常。结论:子宫动脉灌注甲氨蝶呤加栓塞术治疗剖宫产术后子宫疤痕妊娠既能快速止血、预防及控制大出血、避免清宫术中大出血的发生,又能通过药物灌注抑制滋养细胞生长、促进胚囊萎缩凋亡,是一种安全可靠、行之有效的方法。

Objective：To explore the effective therapies to diagnose and treat scar pregnancy and hemorrhage after cesarean section.Methods：Eleven patients with scar pregnancy underwent infusion chemotherapy（methotrexate） via uterine artery combined with embolotherapy under the guidance of AirU DSA digital subtraction angiography,then the curative effect was observed and analyzed.Results：Among eleven patients with uterine scar pregnancy combined with hemorrhage,eight patients underwent uterine curettage after operation under type B ultrasound,the healing was good;three patients received conservative treatment after operation,the healing condition of two patients was good,one patient had small masses in the scar and vaginal discontinuous bleeding at two months after operation,local resection was performed,the healing condition was good.No massive hemorrhage and uterine perforation occurred among all the patients;at a month and a half after operation,β-human chorionic gonadotropin（β-HCG） level returned to normal,menstruation returned to normal at 2-5 months after operation,the ovarian function had no abnormality within six month after operation.Conclusion：Infusion chemotherapy（methotrexate） via uterine artery combined with embolotherapy used for scar pregnancy after cesarean section can stop bleeding quickly,prevent and control massive hemorrhage,avoid the occurrence of massive hemorrhage during uterine curettage,suppress the growth of trophocytes by drug infusion,and promote atrophy and apoptosis of blastosphere,which is a safe,reliable,and effective method.