子宫动脉化疗栓塞治疗剖宫产瘢痕妊娠的临床价值

Clinical Value of Uterine Artery Chemoembolization in the Treatment of Cesarean Scar Pregnancy

目的探讨子宫动脉化疗栓塞(uterine arterial chemoembolization,UACE)治疗剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的临床价值。方法 2012年2月～2017年9月我院采用UACE治疗16例CSP,双侧子宫动脉各灌注甲氨蝶呤40 mg,再用甲氨蝶呤20 mg浸泡的560～710μm明胶海绵颗粒及1 mm×2 cm明胶海绵条栓塞子宫动脉,UACE术后1～3 d终止妊娠。结果 16例均成功行UACE,UACE操作时间15～45 min,(26. 8±9. 0) min,曝光时间5～15 min,(8. 1±2. 8) min。UACE术后清宫8例,出血量10～200 ml,中位出血量50 ml;宫腔镜切除7例,出血量5～150 ml,中位出血量20 ml;1例因清宫大出血行急诊UACE,二次清宫时出血较多终止清宫,MRI提示胎盘植入,行开腹瘢痕妊娠组织切除(术中出血1000 ml)。介入术后3 d内β-h CG下降(204 72. 1±17 076. 4) U/L,恢复正常时间(37. 6±4. 3) d。住院6～28 d,(14. 1±6. 5) d。住院费用(15 750±5305)元。UACE术后出现轻微下腹部疼痛4例,低热2例,恶心、呕吐2例,未出现盆腔感染、子宫缺血坏死及异位栓塞等严重并发症。16例随访3～6个月,1～2个月后均月经恢复,月经恢复正常时间(44. 8±5. 7) d,2例半年后再次妊娠。结论 UACE治疗CSP安全、有效、微创。

Objective To investigate the clinical value of percutaneous uterine arterial chemoembolization(UACE)in the treatment of cesarean scar pregnancy(CSP).Methods A total of 16 cases of CSP in our hospital treated with UACE were selected as the subjects.The patients were injected with methotrexate 40 mg in bilateral uterine arteries,and then 560-710μm gelatin sponge particles and 1 mm×2 cm gelatin sponge,soaked with methotrexate for 20 mg,were used to embolized the uterine artery.The pregnancy was terminated by 1-3 d after UACE.Results All the 16 patients were successfully treated with UACE.The operating time of UACE was 15-45 min(mean,26.8±9.0 min),and the exposure time was 5-15 min(mean,8.1±2.8 min).Curettage after UACE was performed in 8 cases,with a blood loss of 10-200 ml(median,50 ml).Hysteroscopic resection was conducted in 7 cases,with a blood loss of 5-150 ml(median,20 ml).One case underwent emergency UACE because of massive bleeding in uterus curettage.The re-operation of curettage was terminated due to bleeding.Placenta implantation was indicated by MRI,and abdominal scar pregnancy tissue resection was performed(intraoperative bleeding,1000 ml).Within 3 days after intervention,the average level of beta-hCG decreased by(20 472.1±17 076.4)U/L,and the recovery time to normal level was(37.6±4.3)d.The hospital stay was 6-28 days,with an average of(14.1±6.5)days.The hospitalization expense was(15 750±5305)yuan.There were 4 cases of mild lower abdominal pain,2 cases of low fever,2 cases of nausea and vomiting after the operation of UACE.No serious complications happened,such as pelvic infection,uterine necrosis,or ectopic embolism.The 16 cases were followed up for 3-6 months.Menstruation recovered after 1-2 months.The normal time of menorrhagia was(44.8±5.7)d.Two patients were pregnant again 6 months later.Conclusion UACE is a safe,effective,and minimally invasive method for the treatment of CSP.