子宫动脉栓塞术治疗特殊类型异位妊娠临床价值探讨

目的:探讨子宫动脉栓塞术在治疗特殊类型异位妊娠中的临床价值。方法:对17例诊断明确的特殊类型异位妊娠患者(宫颈妊娠4例、剖宫产后子宫瘢痕部位妊娠13例)行双侧子宫动脉栓塞术,术后1～3天行刮宫或清宫等手术治疗。结果:17例患者共成功栓塞34根子宫动脉,栓塞后均行刮宫或清宫术,术中平均出血40ml,胚胎组织易于剥离。所有患者血β-HCG术后2.5周恢复正常。术后并发症主要为下腹部疼痛(17例),恶心、呕吐(5例),发热(4例)。结论:子宫动脉栓塞术可安全、有效阻断宫颈妊娠和剖宫产后子宫瘢痕部位妊娠这两种特殊类型异位妊娠孕囊的血供,降低刮宫或清宫术中及术后子宫大出血的可能性。     

剖宫产术后子宫瘢痕处妊娠的早期诊断与治疗

目的:探讨剖宫产术后子宫瘢痕处妊娠的早期诊断与治疗.方法:收集剖宫产术后子宫瘢痕处妊娠61例患者的临床资料,通过临床观察对其进行分析、总结.结果:61例患者中59例治疗前行B超检查,明确诊断32例(54.2%).19例首选甲氨蝶呤(MTX)治疗,成功率73.7%;25例行清宫术(人工流产术),成功率20.0%;15例首选双侧子宫动脉栓塞术(UAE),成功率80.0%;2例首选子宫切开取胚术加子宫瘢痕缝补术.成功率100%.3例最终行子宫切除术,子宫切除率4.9%.结论:超声检查是诊断剖宫产术后子宫瘢痕处妊娠首选且最主要的方法.对于有条件的医院首选双侧子宫动脉栓塞加宫腔镜手术或清宫术;病情稳定者可行MTX加清宫术.而盲目的清宫术易引起术中、术后大出血.应列为禁忌证.     

剖宫产术后子宫切口瘢痕妊娠的临床治疗研究

目的:探讨剖宫产术后子宫切口瘢痕妊娠的临床治疗方法方法:选取2009年2月至2010年11月于我院就诊的剖宫产术后子宫切口瘢痕妊娠患者16例,其中4例患者服用甲氨蝶呤(MTX)+米非司酮行药物治疗,5例患者行行子宫病灶切除术,6例患者行子宫动脉栓塞术后行清宫术,1例行子宫全切术结果:行药物治疗的4例患者中3例保守治疗成功,1例后行子宫病灶切除术,行手术治疗的患者均治愈出院结论:药物治疗、子宫病灶切除术、子宫动脉栓塞+清宫术、子宫全切术治疗子宫切口瘢痕妊娠均有一定疗效,根据患者病情,选择适当的治疗方法,能改善患者病情,提高治愈率。     

子宫动脉栓塞在剖宫产子宫瘢痕部位妊娠治疗中的应用

目的:探讨选择性子宫动脉栓塞治疗剖宫产子宫瘢痕部位妊娠的应用价值.方法:对10例剖宫产子宫瘢痕部位妊娠的患者行选择性双侧子宫动脉栓塞,6例联合甲氨蝶呤灌注用药.结果:10例患者均顺利实施了子宫动脉栓塞,清宫时出血量少,疗效满意.结论:子宫动脉栓塞是治疗剖宫产子宫瘢痕部位妊娠的一种有价值的方法.     

剖宫产术后子宫瘢痕妊娠20例临床治疗分析

目的探讨剖宫产术后瘢痕妊娠的临床特点、早期诊断及治疗方法。方法对煤炭总医院2010年4月至2014年4月收治的20例剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)患者的临床资料进行回顾性分析。结果超声确诊19例,1例B超可疑葡萄胎清宫后确诊瘢痕妊娠。4例单纯行清宫术;13例甲氨蝶呤+米非司酮治疗后行清宫术;1例清宫+米非司酮;2例阴道大出血患者行子宫动脉栓塞止血,其中1例行清宫术,另1例行清宫后结合MRI检查明确病灶与膀胱的关系,行开腹子宫瘢痕妊娠病灶切除术加子宫修补术。结论有剖宫产史的妇女因停经就诊时,要常规行超声检查,结合MRI检查可进一步明确诊断。子宫动脉栓塞可以迅速止血,药物加清宫可作为治疗子宫瘢痕妊娠的主要方法,必要时行子宫瘢痕病灶切除加子宫修补等治疗措施。     

不同方案治疗剖宫产术后子宫瘢痕妊娠28例临床分析

目的:探讨剖宫产术后子宫瘢痕妊娠(CSP)的临床特点与不同治疗方法的疗效。方法:回顾分析2010年1月至2016年10月同济大学附属同济医院妇科收治的28例CSP患者的临床资料。根据不同治疗方案分为8组:腹腔镜下子宫瘢痕妊娠病灶切除术组2例,宫腔镜下子宫瘢痕妊娠病灶切除术组2例,阴式子宫瘢痕妊娠病灶切除术组2例,子宫动脉栓塞+清宫术组11例,子宫动脉栓塞+宫腔镜下子宫瘢痕妊娠病灶切除术组1例,清宫术组5例,单纯药物治疗组2例,经腹子宫瘢痕妊娠病灶切除术组3例,并进行一定的归纳与总结。结果:手术均取得较好疗效,无一例患者因难治性大出血切除子宫。结论:单纯药物治疗、清宫术、宫腔镜手术治疗CSP存在大出血风险,不作为首选治疗方案,联合UAE可降低发生大出血的风险,腹腔镜手术、经腹手术、阴式手术治疗CSP疗效确定,且阴式手术费用相对较低。     

剖宫产术后子宫瘢痕处妊娠的临床分析

目的探讨剖宫产术后子宫瘢痕处妊娠(CSP)的有效诊治方法。方法选取我院2010年8月~2013年8月收治的剖宫产术后子宫瘢痕处妊娠患者24例作为研究对象,所有患者均符合CSP的临床诊断标准。其中,行子宫动脉栓塞术治疗(栓塞组)7例,行清宫术治疗(清宫组)6例,行阴式病灶清除术(阴式组)7例,行开腹病灶清除术(开腹组)4例。结果清宫组的出血量较栓塞组多,差异有统计学意义(P0.05);清宫组患者的住院时间较栓塞组短,差异有统计学意义(P0.05);开腹组的住院时间较阴式组短,差异有统计学意义(P0.05)。结论治疗剖宫产术后子宫瘢痕妊娠患者应用子宫动脉栓塞术、清宫术、阴式病灶清除术以及开腹病灶清除术等方法,均能取得较好疗效,临床治疗时,根据患者病情为其选择最佳疗法。     

剖宫产术后子宫瘢痕妊娠39例临床分析

目的：探讨剖宫产术后子宫瘢痕妊娠（CSP）的临床特点、诊断和治疗方法。方法：回顾分析2005年4月至2012年6月我院收治的39例CSP患者的临床资料。结果：39例CSP患者均有剖宫产手术史,其中4例有2次剖宫产史。39例CSP患者中,16例误诊为宫内妊娠,其中10例行清宫术中发生阴道大出血伴失血性休克,5例行药物流产失败,复查阴超确诊;1例引产分娩过程中发生大出血,出血量超过3000ml,彩超提示胎盘植入瘢痕;其余23例结合病史及阴道彩超确诊。12例CSP患者行天花粉蛋白＋米非司酮杀胚治疗,9例成功,3例失败者行子宫动脉栓塞术,后行腹腔镜下局部病灶切除术＋子宫修补术。26例行子宫动脉介入及栓塞治疗,22例成功,4例未能吸出孕囊而行腹腔镜下病灶切除术。1例行子宫全切术。患者均痊愈出院。结论：剖宫产史及超声检查可为CSP的诊断提供重要依据。子宫动脉介入及栓塞治疗、花粉蛋白＋米非司酮是治疗CSP的安全有效的方法。     

子宫下段妊娠人工流产术中大出血临床分析--附四例报告

目的 探讨早期子宫下段妊娠人工流产术中大出血的病例特点和保守治疗的方法。方法 回顾性分析1994年5月至2002年7月我们收治的4例子宫下段妊娠行人工流产术中大出血的病例资料。结果 4例患者均有剖宫产史;其中3例停经后有阴道不规则出血;子宫动脉造影显示子宫下段供血区出血;4例均于人工流产术中发生大出血,采用子宫动脉栓塞治疗,止血效果好。无一例因子宫动脉栓塞而行全子宫切除者。结论 有剖宫产史的患者再受孕时,有发生子宫下段妊娠的危险,行人工流产术中易发生难以控制的大出血;子宫动脉栓塞是行之有效的治疗方法。严格剖宫产指征和重视产后避孕,是主要的预防办法。     

宫腔内放置球囊在子宫瘢痕妊娠人工流产术中大出血的应用

目的:探讨子宫瘢痕妊娠患者在人工流产术中大出血的治疗方法。方法:回顾性分析2010年1月至2011年7月收治的5例子宫瘢痕妊娠患者在人工流产术中大出血的临床资料。结果:5例子宫瘢痕妊娠患者在人工流产术中发生大出血,立即行宫腔内放置球囊压迫止血成功后,急诊入院行子宫动脉栓塞术。所有患者均预后良好。结论:子宫瘢痕妊娠患者人工流产术中一旦发生子宫大出血,病情凶险,需紧急处理,而宫腔内放置球囊压迫止血,操作方便、疗效确切,可作为子宫瘢痕妊娠大出血的应急措施。     

Caesarean scar pregnancy: comparative efficacy and safety of treatment by uterine artery chemoembolization and systemic methotrexate injection

Objectives

The aim of this study was to investigate the efficacy and safety of uterine artery embolization (UAE) combined with intra-arterial methotrexate (MTX) infusion for the treatment of caesarean scar pregnancy (CSP), compared with systemic MTX injection combined with uterine curettage.

Study design

A retrospective cohort study. An analysis of CSP patients was performed using records from the Department of Obstetrics and Gynecology in Renji Hospital for the period between January 1, 2000 and December 30, 2010. Twenty-two patients received UAE combined with intra-arterial MTX infusion and in this group 16 patients received uterine curettage after UAE, whereas 25 patients received intramuscular MTX injection and subsequent uterine curettage. The clinical information on these patients and clinical outcomes were reviewed.

Results

All patients in the UAE group were treated successfully and 2 patients in the non-UAE group had to undergo hysterectomy or uterine repair. No patients in the UAE group had recurrent vaginal bleeding of more than 100 ml/day after treatment, while 8 patients in the non-UAE group did, and this difference was significant. The blood loss during uterine curettage in the UAE group was much less than in non-UAE group. The serum β-hCG level in the UAE group recovered more quickly than in the non-UAE group, and hospital stay was significantly shorter in the UAE group.

Conclusions

UAE combined with intraarterial MTX infusion turned out to be an effective and safe treatment for CSP.     

Risk factors for intraoperative hemorrhage at evacuation of a cesarean scar pregnancy following uterine artery embolization

Objective

To determine risk factors associated with massive uterine bleeding during dilation and suction curettage (D&C) after uterine artery embolization (UAE) for the treatment of cesarean scar pregnancy (CSP).

Methods

Data from 128 CSP patients treated with D&C after UAE were analyzed to assess risk factors associated with massive uterine bleeding (blood loss 500 mL or more) during D&C after UAE.

Results

In total, 15 CSP patients had massive bleeding during D&C after UAE. Univariate analysis showed that a greater gestational age (GA), a larger CSP mass size, a thinner myometrium at the implantation site, a GA of 8 weeks or more, a CSP mass diameter of 6 cm or more, and evidence of fetal heartbeat were risk factors for massive bleeding (P < 0.05). In a binary logistic regression analysis, GA of 8 weeks or more and CSP mass diameter of 6 cm or more remained as the only significant risk factors for massive bleeding (OR 11.49 [95% CI 1.08–122.13] and OR 96.59 [95% CI 6.20–150.57], respectively; P < 0.05).

Conclusion

For CSP masses with a GA of 8 weeks or more and a diameter of 6 cm or more, the outcome of surgical evacuation after UAE tends to be unsatisfactory.     

Clinical efficacy analysis of different therapeutic methods in patients with cesarean scar pregnancy

ObjectiveThe purpose of this study was to analyze the clinical efficacy of five therapeutic strategies in patients with CSP.Materials and methodsA total of 135 CSP patients were included and divided into five groups based on the treatment they received, including transvaginal resection (Group A), laparoscopic resection (Group B), uterine arterial embolization (UAE) combined with hysteroscopic curettage (Group C), UAE combined with uterine curettage (Group D), and hysteroscopic curettage (Group E). To investigate the clinical efficacy of these strategies, intraoperative bleeding, serum β-hCG levels and recovery time, menstruation recovery time, hormone levels at 1 month after treatment.ResultsPatients in group A had the lowest postoperative serum β-hCG levels, and the shortest recovery times of both serum β-hCG and menstruation, followed by patients in group B. Group C and D had small amount of blood loss. The hospital stays and costs were low in group E. In addition, the sex hormone levels showed no significant difference among the five groups.ConclusionOur results indicated that resection surgery and UAE have good curative effects, but high hospital costs in CSP treatment. The selection of an optimal treatment regimen for CSP should be carried out based on specific conditions of the patients.     

甲氨蝶呤联合子宫动脉栓塞术后定点吸胚术治疗剖宫产术后子宫瘢痕妊娠51例临床分析

目的:探讨甲氨蝶呤(MTX)预处理联合子宫动脉栓塞术(UAE)后超声引导下定点吸胚术治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床疗效和最佳给药方法。方法:回顾性分析首都医科大学附属朝阳医院2011年1月—2014年12月收治的采用MTX预处理联合UAE后超声引导下定点吸胚术治疗的51例CSP患者资料,按MTX不同给药方式分为3组。A组(23例):MTX全身用药后行UAE,然后行定点吸胚术;B组(11例):MTX子宫动脉灌注化疗栓塞(UACE)后行定点吸胚术;C组(17例):MTX全身用药联合UACE,再行定点吸胚术。比较各组患者的基本信息、治疗前情况和术中情况,并评估治疗效果指标。结果:3组患者均一次性手术成功,无需腹腔镜手术等二次处理,无膀胱损伤、子宫穿孔和子宫切除等并发症发生。3组患者出血量、手术时间、血清人绒毛膜促性腺激素β亚单位(β-hCG)转阴时间、包块吸收时间、手术成功率和并发症发生率比较,差异无统计学意义(均P>0.05)。B组的住院时间和住院费用较另2组减少,差异有统计学意义(均P<0.05)。孕囊或包块最大直径在Logistic回归模型中有统计学意义(OR=1.094,95%CI:1.012～1.183,P=0.024)。结论:MTX预处理联合UAE后定点吸胚术疗效确切、手术难度小、创伤小且花费少,可广泛用于治疗内生型和外生型CSP,推荐UACE作为术前预处理的首选方式,该方法对于病灶最大直径<4.3 cm的患者更安全。     

224例剖宫产术后子宫疤痕妊娠不同治疗方法的临床疗效分析

目的:比较剖宫产术后子宫疤痕妊娠(CSP)不同治疗方法的临床疗效。方法:回顾分析在福建省妇幼保健院妇产科诊治的224例CSP患者,按首治方案分组:药物治疗加清宫术(A组),子宫动脉栓塞(UAE)加清宫术(B组),经腹CSP病灶切除加修补术(C组),腹腔镜下CSP病灶切除加修补术(D组)。根据治疗药物不同将A组再分为:甲氨蝶呤(MTX)(局部/全身)组(A1组),天花粉组(A2组),MTX(局部/全身)加天花粉组(A3),米非司酮组(A4)。根据术前是否行UAE,将C组分为:术前未行UAE(C1组),术前行UAE(C2组)。结果:A、B、C、D组的治疗成功率分别为90.12%、95.61%、100%和100%,差异无统计学意义(P=0.255);入院时血β-HCG、CSP分型、手术出血量、手术时间、住院时间及住院费用比较,差异均有统计学意义(均P0.05)。A1~A4组的治疗成功率分别为85.37%、100%、83.33%、96.43%,差异无统计学意义(P=0.381),入院时血β-HCG、术后2~3天血β-HCG下降程度、手术出血量、手术时间差异无统计学意义(均P0.05),住院时间和住院费用差异有统计学意义(均P=0.000)。C1、C2组的治疗成功率均为100%;入院时血β-HCG、术后2~3天血β-HCG下降程度和住院费用差异有统计学意义(均P0.05);手术出血量、手术时间、住院时间差异无统计学意义(均P0.05)。结论:根据入院时血β-HCG水平、B超情况选择恰当的治疗方案,均能取得好的临床效果。药物治疗采用MTX、或天花粉、或米非司酮临床效果相似,住院时间长,费用增加。UAE后清宫术,可以减少术中出血量。经腹疤痕妊娠病灶切除加子宫修补,术前行UAE未减少术中出血量。     

Reproductive outcomes of cesarean scar pregnancies treated with uterine artery embolization combined with curettage

ObjectiveThe aim of this study was to review the reproductive outcomes of women with a cesarean scar pregnancy (CSP) treated with dilation and curettage (D&C) after uterine artery embolization (UAE).Materials and methodsThis was a retrospective study to review women who received UAE followed by D&C for CSP between January 2010 and December 2019 at the Changhua Christian Hospital, Changhua in Taiwan. Data were collected from both electronic and paper medical records. Patients were contact via phone call to follow up reproductive outcomes between January 2021 and March 2021. These subsequent reproductive outcomes (including pregnancy rate, secondary infertility rate, miscarriage rate, live birth rate, and recurrent CSP rate) were recorded and analyzed.ResultsA total of 53 cases of women who received UAE followed by D&C for CSP were identified. The women's average age was 34.8 ± 5.1 years. The mean gestational age at diagnosis was 6.2 ± 1.1 weeks. The mean level for human chorionic gonadotropin was 23,407.7 ± 29,105.5 mIU/ml. The average of blood loss during D&C was 19.2 ± 43.6 ml. The average hospitalization time after D&C was 3.5 ± 1.1 days. Of the 53 cases, 10 patients were lost to follow-up and 43 patients agreed to follow-up on reproductive outcomes in 2021. Twenty-three patients who desired to conceive were analyzed. Nineteen out of these 23 women (82.6%) succeeded in conceiving again and gave birth to 15 healthy babies (78.9%). Only one woman (1/19, 5.3%) experienced recurrence of CSP. The average time interval between previous CSP treatment and subsequent conception was 10.4 ± 6.7 months.ConclusionUAE combined with curettage treatment in CSP patients results in a positive rate of subsequent pregnancy outcomes. This minimally invasive procedure may be considered as one of the treatment options for CSP, as it enables preservation of fertility after treatment.     

Analysis of the Reproductive Outcome of Patients with Cesarean Scar Pregnancy Treated by High-Intensity Focused Ultrasound and Uterine Artery Embolization: A Retrospective Cohort Study

Study ObjectiveTo investigate risk factors for infertility and recurrent cesarean scar pregnancy (CSP) after previous CSP.DesignA retrospective cohort study (Canadian Task Force classification II-1).SettingUniversity hospital.PatientsBetween January 2007 and April 2016, a total of 650 patients were included, all diagnosed with CSP and treated by high-intensity focused ultrasound (HIFU) and uterine artery embolization (UAE), followed by suction curettage under hysteroscopic guidance.InterventionNone.Measurements and Main ResultsFollow-up of the reproductive outcomes ended in June 2017. A total of 135 of the 650 patients with CSP were involved in the study, among whom 32 became infertile, 78 had an intrauterine pregnancy, and 25 had recurrent CSP after previous CSP. Age (≥35 years; odds ratio [OR], 4.252; p = .002), β-human chorionic gonadotropin (≤5000 mIU/mL; OR, 3.778; p = .011), and longer duration of amenorrhea (>56 days; OR, 2.507; p = .05) were risk factors for infertility. Treatment with UAE (OR, 5.796; p = .003), more abortions (≥4; OR, 2.851; p = .022), and being asymptomatic (OR, 4.175; p = .039) were risk factors for recurrent CSP. There was no statistically significant difference in the subsequent outcomes of pregnant women in the HIFU and UAE groups (p >.05).ConclusionMore attention should be given to subsequent reproductive outcomes after CSP, not only for intrauterine pregnancy, but also for infertility and recurrent CSP. Early diagnosis and treatment of CSP could reduce the risk of infertility and recurrent CSP. HIFU seemed to be superior to UAE in reducing the risk of recurrent CSP. Patients with CSP should adhere to strict contraception if they do not desire more children.     

Uterine artery embolization for the treatment of uterine leiomyomata.

OBJECTIVES: To evaluate the results of the uterine artery embolization (UAE) for the treatment of uterine fibroids. METHODS: Twenty-six patients with ultrasonographic diagnosis of uterine leiomyomata were submitted to UAE with polyvinyl alcohol particles. Imaging and clinical follow-up was performed before the procedure, at 3 months, and 1 year after. RESULTS: All procedures but one were technically successful. Control of menorrhagia and pelvic pain were reported after UAE by 87.5% and 84.2% of patients, respectively. The initial medium uterine volume was 385 cm(3), after 3 months 255 cm(3) and after 1 year 202 cm(3). The mean uterine volume decrease was 29% after 3 months and 41% after 1 year of follow-up (P<0.001). Clinical and biochemical findings consistent with ovarian failure were observed in three patients (12% of the patients). CONCLUSIONS: UAE represents a new therapeutic approach in the treatment of uterine leiomyomata. The procedure appears effective in controlling symptoms and represents an alternative to hysterectomy.     

腹腔镜双侧髂内动脉临时阻断下子宫修补联合宫腔镜清宫术在Ⅲ型剖宫产瘢痕部位妊娠中的应用

目的 探讨腹腔镜下髂内动脉可逆性结扎及子宫修补联合宫腔镜下清宫术在Ⅲ型剖宫产瘢痕部位妊娠术中的疗效和安全性.方法 回顾性分析2017年11月～2020年11月广州医科大学附属广州市妇女儿童医疗中心收治的剖宫产瘢痕部位妊娠患者135例,其中Ⅲ型患者32例,根据术前处理措施不同,分为髂内动脉临时阻断组(21例)和子宫动脉栓...     

子宫动脉栓塞术治疗子宫肌瘤(附10例报告)

目的 评价子宫动脉栓塞(UAE)治疗子宫平滑肌瘤的疗效。方法 10例患者主要症状包括月经过多,尿频,盆腔疼痛等。子宫平滑肌瘤的诊断经影像学检查和专科医师检查确定,并排除与症状有关的其他妇科疾病。10例患者双侧子宫动脉栓塞9例,单侧者1例。栓塞剂为PVA微球。 结果 栓塞技术成功率为95％,无严重并发症。随访9例,术后症状均明显改善,术后4个月肿瘤体积平均缩小47％,1例术后肿瘤体积无明显变化,与仅行单侧栓塞有关。结论 UAE是一治疗子宫肌瘤的安全疗法,近期疗效好,远期疗效尚待观察。