子宫动脉栓塞、局部MTX及活血化瘀中药三联疗法治疗胎盘植入

Therapy Combined of Uterine Artery Embolization,Local MTX Injection and Chinese Medicine for Placenta Implantation

目的：探讨子宫动脉栓塞、甲氨蝶呤及活血化瘀中药联合疗法治疗胎盘植入的临床疗效和安全性．、方法：选取本院收治的胎盘植入患者64例，随机分为两组；对照组32例，以子宫动脉栓塞术加甲氨蝶呤进行治疗；观察组32例，在子宫动脉栓塞术加甲氨蝶呤的基础上口服活血化瘀中药；对比两组患者的近远期治疗效果。结果两组患者术后均有少量阴道出血，平均出血量无统计学差异（P〉0．05）；但观察组患者的HCG降低速度显著优于对照组（P〈0．05），胎盘血流信号消失时间明显缩短（P〈0．05）。观察组术后胎盘自行排出12例（37．5％）、清宫手术19例（59．4％）、摘除子宫1例（3．13％）；对照组术后胎盘自行排出5例（15．6％）、清宫手术20例（62．5％）、摘除子宫7例（21．8％）；观察组的自行排出率和保宫率均显著高于对照组（P〈0．05）。此外，两组患者均无肝肾异常、骨髓抑制等严重不良反应，仅对照组4例、观察组6例胃肠道反应，对症治疗后缓解；随访2～6个月，保留子宫患者生理周期均恢复正常，B超复查子宫形态良好、无植入光团或异常肌层结构。结论：子宫动脉栓塞、甲氨蝶呤及活血化瘀中药联合疗法治疗胎盘植入疗效确切、保宫率高、并发症少，值得临床推广。

Objective ： To explore the clinical efficiency and security of the therapy combined of uterine artery emboli- zation, local MTX injection and Chinese medicine to treat placenta implantation. Methods ： 64 cases of patients with pla- centa implantation were selected and divided into 2 groups （ n = 32） randomly. Patients in Control group were treated wittl therapy combined of uterine artery embolization and local MTX injection, while patients in Observation group were also treated with Chinese medicine on base of that. Recent and long term follow - up therapeutic effects were contrastively ana- lyzed between groups. Results： There was a little bleeding in both the two groups, with no statistic difference between groups （ P 〉 0.05 ） ; But it was obviously that the HCG reduced speed and placental blood signals disappear time of pa- tients in Observation group were faster and shorter than those in Control group （ P 〈 0.05 ）. The self elimination rate, ute-rus curettage rate and uterus removal surgery rate in Observation group were respectively 37.5% （ 12 cases）, 59.4% （ 19 cases） and 3.13% （1 cases）;which in Control group were respectively 15.6% （5 cases）, 62.5% （20 cases） and 21.8% （7 cases） ;the self elimination rate and uterus reservation rate of Observation group were significantly higher than that of Control group （ P 〈 0.05 ）. In addition, there was no serious adverse reactions such as liver or kidney damage, or marrow suppression, besides 10 cases of gastrointestinal reaction （4 Controls and 6 Observations）, which were all eased after symptomatic treatment; We completed a followed - up for 2 - 6 months, and all patients reserved uterus got normal physiological cycles, which uterus recovered in morphology and function. Conclusion： therapy combined of uterine artery embolization, local MTX injection and Chinese medicine has high efficiency and security to treat placenta implantation and is worthy of clinical promotion.