子宫动脉灌注化疗及栓塞治疗剖宫产瘢痕妊娠疗效和失败因素分析

The efficacy and failure factors of uterine artery methotrexate infusion and embolization in treatment of cesarean scar pregnancy

目的观察子宫动脉栓塞结合甲氨蝶呤(MTX)灌注治疗剖宫产瘢痕妊娠(CSP)疗效,并分析可能导致失败的三个因素。方法收集36例CSP患者并行双侧子宫动脉MTX灌注及栓塞治疗,其中6例重症阴道出血患者立即行介入手术治疗。通过血清β人绒毛膜促性腺激素(β-HCG)、超声、MR和临床症状评估临床效应。结果 34例患者成功实施介入治疗技术。6例大量阴道出血患者达到了立即止血目的。36例患者没有发生感染和子宫坏死,但有16例患者感到下腹疼痛。33例患者保存了子宫,3例行子宫切除术。结论经导管动脉灌注化疗栓塞术能有效治疗高风险CSP。合理的MTX用量、合适的栓塞材料和靶动脉完全栓塞是介入治疗成功的三个关键因素。

Objective To observes the therapeutic efficacy of uterine artery embolization combined with methotrexate infusion in the treatment of cesarean scar pregnancy（CSP） and to analyze three factors related to failure of the treatment. Methods Thirty-six CSP patients were treated with uterine artery embolization combined with MTX infusion. Among them six patients with severe hemorrhage were immediately performed the interventional operation. The clinical effects were evaluated by the improvement of symptoms, serum β-hCG, ultrasound and MR. Results The interventional treatment was technologically successful in 34 patients. Immediate hemostasis was achieved in 6 patients with massive colporrhagia. No occurrence of infection and uterine necrosis was observed. 16 women suffered abdominal pains. 33 patients＇ uteri were preserved, while 3 underwent hysterectomy eventually. Conclusion Transcatheter arterial ehemoembolization is effective to treat high-risk CSP. The three factors including adequate MTX dosage, appropriate embolie materials, and complete embolization of the target arteries that supply blood to embryo in the scar are the key points of the successful therapy.