输卵管妊娠的介入治疗

目的：探讨介入治疗输卵管妊娠的新方法。材料与方法：采用Seldinger技术，对12例输卵管妊娠患进行超选择性子宫动脉插管经导管灌注氨甲蝶呤（MTX）后，明胶海绵颗粒栓塞子宫动脉，术后定期监测血β-HCG水平变化及盆腔情况。结果：输卵管妊娠在血管造影下呈Ⅰ、Ⅱ、Ⅲ型3种表现。I型表现2例，Ⅱ表现3例及Ⅲ型表现中2例，达治愈标准，血β-HCG在术后12天内降至正常，月经在32-42天内恢复正常，月经干净3天行HSG，其中5例输卵管显示通畅。2例输卵管远端不全梗阻。治愈7例中1例术后半年宫内妊娠，开腹手术5例血管造影均呈Ⅲ型表现。其中2例病理切片证实胚胎组织已坏死。结论：超选择性子宫动脉插管化疗药物灌注及血管栓塞治疗输卵管妊娠，能保留生殖器官，保存2生育能力，不失为又一种保守治疗输卵管妊娠的方法，对血管造影下，不同表现类型与治疗效果上的差异需进一步深入研究。

An interventional therapy for the treatment of tubal pregnancy

Purpose: To study a new method of interventional therapy for treatment of tubal pregnancy.Marterials and the: Using Seldinger's method, 12 cases received methotrexate (MTX) perfusion throughthe superselective uterus artery catheterization,then embolism of uterus artery with spongia Gelatim were applied.The concetration of blood B-HCG and the changs of pelvic cavity were regularly monitored postoperatively. Re-sults:The appearances of tubal pregnancy were classified into three type:I,II,III according to angiographicfunding. Type I 2, type II 3,and 2 cases of type III achieved criteria of cure,the concentration of blood B-HCG reduced to the normal level within 12 days postoperatively and menistruation recovered within 32~42 days,7 cases demonstrated patent oviduct,2 cases with incomplete obstruction of distal portion of oviduct. One casewas pregnant half year postoperatively. 5 cases who underwent abdominal operation coincide with the features oftype III. In 2 of them, the pathological section confirmed the necrosis of embryonic tissue. Conclusion:The MTXdrug perfusion and vascular embolization by superselective uterus artery catheterization for tubal pregnanic couldpreserve fertility. The method might be helpful in treatment for the tubal pregnancy conservatively.the differenttherapeutic effect of various angiographic types should be fuother investigated.[