双侧子宫动脉化疗栓塞术治疗剖宫产术后瘢痕妊娠61例的疗效分析

Curative effect analysis of bilateral uterine arterial chemobolization for cesarean scar pregnancy treatment

目的探讨子宫动脉化疗栓塞术在剖宫产术后瘢痕妊娠治疗中的临床应用价值。方法选择佛山市妇幼保健院2007年6月至2012年3月收治的剖宫产术后瘢痕妊娠患者61例,采用Seldingers方法,经双侧子宫动脉灌注甲氨蝶呤(MTX),再以明胶海绵栓塞,72 h内于B超引导下行清宫术,记录患者术后阴道流血量及血清人绒毛膜促性腺激素(β-HCG)。结果 61例患者均成功实施子宫动脉化疗栓塞术,60例患者术后阴道流血明显减少,术后清宫平均手术时间为(20.78±2.81)min,术中出血量(47.07±7.71)ml,血清人绒毛膜促性腺激素(β-HCG)在一周内下降明显。1例患者子宫动脉化疗栓塞术后胚胎继续生长而行腹腔镜妊娠物清除及瘢痕修复术。结论双侧子宫动脉化疗栓塞术治疗剖宫产术后瘢痕妊娠近期疗效好,可以保留患者生育功能,值得临床推广及应用。

Objective To investigate the clinical application of bilateral uterine arterial chemoembolization in treating uterine scar pregnancy after cesarean section. Methods A total of 61 consecutive patients with cesarean scar pregnancy from January 2005 to December 2012 at Maternal and Child Health Hospital of Foshan City were enrolled in the study. With Seldingers technique, MTX were infused separately via bilateral uterine arteries, which was followed by the embolization of bilateral uterine arteries with Gelfoam.. Curettage of uterus was carried out within 72 hours after the procedure. The clinical results were observed. Results Uterine arterial ehemoembolization was successfully accomplished in all the 61 patients. An average operation time and hemorrhage volume were （ 20.78 ±2.81 ） min and （47.07 ± 7.71 ） ml respectively. Serum human chorionic gonadotropin decreased significantly within a week. 1 patient after interventional treatment of embryos continue to grow laparoscopic gravid line removal and scar revision surgery. Conclusion The emergency bilateral uterine arterial chemoembolization is a safe and effective treatment for massive hemorrhage due to cesarean scar pregnancy with no serious complications, therefore, this technique is worth being used in clinical practice.