子宫动脉介入栓塞合并氨甲喋呤注射在胎盘完全滞留中的应用

Application of uterine artery embolization combined with methotrexate injection in treatment of complete placental retention

目的观察子宫动脉介入栓塞+MTX子宫动脉注射用于阴道分娩后胎盘完全滞留的临床效果。方法回顾性分析华中科技大学同济医学院附属湖北妇幼保健院2012年1月至2018年1月期间阴道分娩后胎盘完全滞留的26例患者的病例资料,12例使用子宫动脉介入栓塞+MTX作为观察组,14例未做子宫动脉介入作为对照组,比较两组患者阴道出血量、胎盘娩出时间、住院天数等指标。结果观察组阴道出血量为(543.3±190.4)mL,高于对照组的(408.6±109.3)mL(P<0.05)。观察组胎盘娩出平均时间为6.5 d,低于对照组的22.6 d(P<0.05);观察组住院天数为(9.6±2.4) d,低于对照组的(15.7±5.0) d(P<0.05)。结论阴道分娩胎盘滞留行子宫动脉介入栓塞加MTX子宫动脉注射可迅速止血、促进胎盘的坏死脱落以及排除,为胎盘钳夹创造条件。对胎盘穿透性植入导致的胎盘完全滞留,非手术治疗仍需谨慎。

Objective To investigate the effect of uterine artery embolization combined with methotrexate injection for the treatment of complete placental retention. Methods A total of 26 cases of complete placental retention were interviewed by retrospective study method from January 2012 to January 2018 in our hospital. According to different therapeutic method, the selected cases were divided into two groups: observation group containing 12 cases using methods of uterine artery embolization combined with methotrexate injection through uterine artery, and control group containing 14 cases only using traditional methods. The therapeutic effects between the two groups were compared. Results The amount of vaginal bleeding in the observation group was(543.3±190.4)mL,which was higher than that in the control group(408.6+109.3 mL)(P<0.05). The average time from placental complete excretion to baby delivery in the observation group was 6.5 days,which was lower than that in the control group(22.6 days, P<0.05). The length of hospitalization days in the observation group was 9.6 days,which was less than that in the control group(15.7 days, P<0.05). Conclusion Uterine artery interventional embolization combined with methotrexate uterine artery injection in vaginal delivery with complete placental retention can quickly stop bleeding and promote placental necrosis and abscission, exretion,and then create conditions for next placental clam. Conservative treatment still requires special attention to complete placental retention with placenta percreta.