31例介入合并甲氨蝶呤治疗子宫瘢痕妊娠的分析

An analysis of uterine artery embolization combined with methotrexate in the treatment of cesarean scar pregnancy for 31 cases

回顾性分析31例安徽省妇幼保健院收治的子宫下段剖宫产术后切口瘢痕妊娠患者的临床资料。其中22例明确诊断给予介入手术;1例切口妊娠处破裂急诊入院行介入治疗;另8例由于诊断错误在入院前均经过药流或清宫等处理而有活动性阴道流血入院。结果显示31例患者接受介入及其他治疗后,均未行子宫切除术并且人绒毛膜促性腺激素(β-HCG)均有明显下降。其中24例行介入后清宫术;3例介入后手术行子宫瘢痕切除术;4例介入后药物保守治疗。表明介入治疗为治疗子宫瘢痕妊娠包括急诊瘢痕妊娠合并大出血的最有效措施,它降低了子宫切除率。

31 patients from Anhui province maternal and child health care with cesarean scar pregnancy （CSP） treated with UAE （before or after uterine curettage） were analyzed retrospectively. 12 subjects with a definite diagnosis of CSP were offered preventive UAE. 1 case of an emergency rupture of the CSP patient was offered emergency interventional therapy. The other eight patients, who were misdiagnosed as having an intrauterine pregnancy,with the symptoms of active vaginal bleeding were treated with emergency UAE after uterine curettage. The results showed all the 31 patients with CSP were resolved successfully without hysterectomy and had a significant decrease on the data of β-HCG. 24 patients received preventive UAE combined with methotrexate followed by uterine curettage. 3 patients received a excision of the scar in the uterus after UAE. 4 patients had a UAE combined with conser- vative medication. Results showed that UAE might be an effective means of treating CSP, including treatment in an emergency setting. It decreases the incidence rate of hysterectomy.