子宫动脉灌注化疗栓塞治疗宫角妊娠的临床观察

Clinical Observation of Cornual Pregnancy Treatment by Uterine Artery Embolization

目的探讨子宫动脉灌注甲氨喋呤加明胶海绵颗粒栓塞术对宫角妊娠治疗的临床效果。方法回顾性分析宫角妊娠36例患者的临床资料,所有患者均经子宫动脉灌注甲氨喋呤100 mg,再予以明胶海绵颗粒栓塞阻断双侧子宫动脉血流,以及其终末端分支血流。结果 35例患者经治疗后妊娠囊自然流产或吸收,患者均未出现明显骨髓抑制和肝肾功能损害等不良反应,仅部分出现轻微的栓塞综合征。行子宫动脉灌注化疗栓塞治疗后4~11周血β-HCG降至正常,6~13周经阴道超声检查孕囊消失。1例患者因孕囊过大,于治疗后2周子宫内见孕囊及胎心搏动,血β-HCG为12467.7 IU/L,超声引导下孕囊内注入甲氨喋呤80 mg后2 d在宫腔镜下行清宫术。结论子宫动脉灌注甲氨喋呤化疗加明胶海绵颗粒栓塞术治疗宫角妊娠的手术创伤小,术后恢复快,可降低切除子宫的风险,较大程度上保留了患者的生育功能,是一种治疗宫角妊娠有效的保守措施。

Objective To evaluate the clinical value of the uterine artery embolization therapy in the treatment of cornual pregnancy. Methods The clinical data of 36 patients with cornual pregnancy were retrospectively analyzed. All the patients were subjected to the treatment of bilateral uterine artery infusion methotrexate（MTX） combined with gelatin sponge particles. Results In the 36 patients,35 cases were spontaneous abortion or absorption of pregnancy after treatment,there was no significant bone marrow suppression and liver and kidney function damage and other toxic side effects. After 4 - 11 weeks of treatment, the blood β-HCG was decreased to normal, and the gestational sac was disappeared in 6 -13 weeks by ultrasound examination. Because of the gestational sac was too large, 1 case failed, uterine artery MTX infusion combined with uterine artery embolization with gelatin sponge particles after 2 weeks, pregnancy sac and fetal heart beat can be seen in the uterus by ultrasound examination, β- HCG to 12467.7 IU/L, ultrasound guided injection 80 mg of methotrexate in the gestational sac, then Curettage under hysteroscopy after 2 days. Conclusion Uterine artery embolization in the treatment of early cornual pregnancy can significantly reduce the risk of hysterectomy and the reproductive function of the maximum possible retention of patients, it is a minimally invasive, low risk of anesthesia with mild side effects, efficacy significant treatment technology.