宫腔镜联合子宫动脉栓塞术在剖宫产切口瘢痕妊娠中应用的可行性分析

Feasibility Analysis of Hysteroscope Combined with Uterine Artery Embolization in Cesarean Scar Pregnancy

目的：探讨宫腔镜联合子宫动脉栓塞术（UAE）在剖宫产切口瘢痕妊娠（CSP）中应用的优势及可行性。方法：回顾性分析我院2011年1月至2013年1月收治的CSP患者中的19例（入院超声检查提示CSP最大直径≤6cm）的临床资料，均采用先行UAE联合动脉内注入甲氨蝶呤（MTX），在血β-HCG降至1000U／L左右、超声检查提示病灶距浆膜层厚≥0．2cm时，行宫腔镜手术切除妊娠病灶。结果：@UAE联合动脉内注入MTX手术持续时间约20分钟，UAE术中无副损伤及特殊情况发生。血B-HCG水平由术前的17804．76±11713．55U／L降至宫腔镜手术前988．54±165．83U／L，病灶直径由3．64±1．01cm缩小到3．13±0．98cm。②宫腔镜手术持续时间18～40分钟，术中出血量17．37±7．32ml，无中转开腹，术中无并发症及副损伤，血B—HCG于术后2～4天降至112．71±35．16U／L出院。术后30～45天恢复月经。结论：CSP经过UAE联合动脉内注入MTX的“预处理”，结合血B．HCG及超声检查选择行宫腔镜手术，可获得满意治疗效果，可成为被患者接受的治疗方法。

Objective：To evaluate the feasibility of combined with uterine artery embolization（UAE） in cesarean car pregnan- cy（CSP）. Methods： Retrospective analysisof 19 cases of patients with CSP （CSP diameter 6 cm or less by ultrasound）from January2011 to January 2013. All cases were received the UAE and arterial injection of methotrexate（MTX）. When the blood beta HCG fell to about 1000 U/L and thickness of the lesions to serous membrane were≥0.2 cm by ultrasound,pregnancy le- sions were resected by hysteroscopy surgery. Results：（1） The duration of UAE surgery combined with artery injection MTX was about 20 minutes, without injury or other emergency. Blood beta HCG levels decreased from 17804. 76 ±11713. 55 U/L to 988.54 ±165.83 U/L before hysteroscopy surgery,and lesion diameter decreased from 3. 64 ± 1.01 cm to 3. 13 ± 0.98 cm. （2） Hysteroscopy surgery duration was 18 to 40 min, and theintraoperative blood loss was 17. 37 ±7. 32 ml, without transit opera- tion, intraoperative complication and injury. Postoperative blood beta HCG decreased to 112.71 ± 35. 16 U/L within 2 - 4 days. Menstruation restored after 30 to 45d. Conclusions. Hysteroscopy surgery with pretreatment of UAE combined with MTX injec- tion could achieve satisfactory outcome for CSP,which should become one of the appropriate choice for CSP patients.