子宫动脉化疗栓塞术治疗植入性胎盘的疗效观察

Efficacy of uterine artery chemoembolization for treatment of placenta accreta

目的探讨子宫动脉化疗栓塞术治疗植入性胎盘的疗效及安全性。方法选择2007-01-01~2013-09-31在广西医科大学产科住院并接受子宫动脉化疗栓塞术治疗的胎盘植入者17例,其中产后组10例(院外产后未能娩出胎盘),引产组7例(院内引产)。引产患者栓塞术后即行利凡诺引产术,观察所有患者产后出血、残留胎盘组织排出时间、人绒毛膜促性腺激素(β-HCG)转阴时间、月经恢复时间、产褥感染情况,比较产后患者与引产患者、清宫患者与无清宫患者的上述指标。结果 17例患者中2例栓塞术后3周因产后出血行子宫切除术,成功15例,成功率为88.24%。5例(清宫组)联合清宫术,10例(未清宫组)胎盘自行吸收或排出,平均吸收或排出时间(70.50±25.82)d,β-HCG 1周内下降80.0%~97.5%,平均转阴性时间(32.5±15.83)d。月经平均恢复时间(52.27±20.25)d,产后患者10例栓塞治疗前分娩时的出血量平均(830±141.81)ml,引产患者7例栓塞治疗后分娩时的出血量平均(316.67±116.91)ml,比较差异有统计学意义(P<0.01),产后组栓塞治疗后的子宫切除率低于引产组(P<0.05),β-HCG转阴时间、月经恢复时间、产褥感染比较差异无统计学意义。采用清宫术患者的β-HCG转阴时间、月经恢复时间短于未清宫者,差异有统计学意义(P<0.01),但子宫切除、产褥感染和产后出血比较差异无统计学意义(P>0.05)。结论子宫动脉化疗栓塞术治疗植入性胎盘可降低产后出血率,满足了患者保留子宫的愿望,联合清宫术可使β-HCG转阴时间、月经恢复时间缩短,值得临床推广。

Objective To investigate the clinical efficacy and safety of uterine artery chemoembolization for the treatment of placenta implantation.Methods From January 1, 2007 to September 31, 2013,17 patients with placenta implantation were treated with uterine artery chemoembolization at the First Affiliated Hospital of Guangxi Medical University. The patients in group B were treated simultaneously with Rivanol intra-amniotic membrane injection for artificial laboring. The postpartum hemorrhage, placental tissue residue discharge time, β-HCG clearance time, recovery time of menstruation and puerperal infection were observed in all the patients.Results Two cases needed hysterectomy because of severe hemorrhage. 15 cases were successfully treated with chemoembolization（88.24%）. The placentas of 10 cases were self-absorbed or discharged, with an average of （70.50±25.82 ）days. The serum β-HCG dropped from 80.0% to 97.5% during one week, and decreased to the normal range of （32.5±15.83 ）days. The average time of getting normal menses was （52.27±20.25 ）days. The average amount of blood loss of group A（830±141.81）ml was significantly less than that of group B（316.67±116.91）ml（P〈0.01）. There were no significant differences in the serum β-HCG decreasing to normal, getting normal menses and puerperal infection between them. The time of the serum β-HCG decreasing to normal and getting normal menses when using curettage was shorter than that when not using curettage（P〈0.01）, but hysterectomy, puerperal infection and postpartum hemorrhage were not different.Conclusion The treatment of placental implantation using uterine artery chemoembolization can reduce postpartum hemorrhage, reserve uterus, and combining with chemoembolization curettage can reduce the time of the serum β-HCG decreasing to normal and getting normal menses.