经子宫动脉一次性灌注氨甲喋呤及栓塞治疗输卵管妊娠

One-shot Infusion Methotrexate Combined with Embolization Via Uterine Artery for Treatment of Fallopian Tubal Pregnancy

目的 :探讨输卵管妊娠的血供特征及子宫动脉一次性灌注氨甲喋呤 (MTX)及栓塞的临床疗效。材料与方法 :2 4例输卵管妊娠 (未破裂者 10例 ,发生流产或破裂者 14例 )行子宫动脉造影并灌注MTX 5 0～ 80mg及明胶海绵颗粒栓塞 ,术后定时监测尿人绒毛膜促性腺激素 (β hCG)及肿块变化。 6例未破裂者 ,治疗前行彩色多普勒超声观察宫旁肿块血流特征。结果 :宫旁肿块为富血管染色 ,具有较低血流阻力指数 (RI 0 37)。 2 1例治疗成功 ,成功率为 87 5 %。 3例失败 ,其中 2例术前尿 β hCG >10× 10 3IU/L。影响治疗成功的主要因素为术前尿 β hCG水平 ,而与孕龄、包块大小及破裂与否无明显关系。结论 :经子宫动脉一次性灌注氨甲喋呤及栓塞治疗输卵管妊娠安全有效 。

Purpose: To study blood supply charater of fallopian tubal pregnancy and efficacy of one shot infusion methotrexate (MTX) combined with embolization via uterine artery for fallopian tubal pregnancy. Meterials and Methods: 24 cases with fallopian tubal pregnancy (unruptured 10 cases, ruptured or aborted 14 cases) were treated by one shot infusion MTX (50～80mg) combined with gelfoam partical embolization via uterine artery catheterized by percutaneously transfemoral artery method. The urine β hCG and size of ectopic pregnancy mass were monitored regularly. Unruptured 6 cases before theraphy were observed by Color Doppler Ultrasonography. Results: Uterine artery angiography and Color Doppler Ultrasonography showed enlarged uterine artery, vasculatrity pregnancy mass, lower blood flow resistance index (RI, 0 37). 21 cases (unruptured 8 cases, abortion or ruptured 13 cases) were successfully treated, success rate was 87.5%. The failed 3 cases were adopted surgical approach, among 3 cases, 2 cases with urine β hCG>10×10 3IU/L before therapy were not significantly falling β hCG level after theraphy. Main affective factor of success theraphy was higher urine β hCG titers before treatment, it was not related to gestation age and size of ectopic mass and rupture or abortion. Conclusions: One shot infusion methotrexate combined with embolization via uterine artery is safe and effective for treatment of fallopian tubal pregnancy. It can prevent and control severe hemorrhage.