子宫动脉化疗栓塞在治疗完全性胎盘植入中的应用

目的:探讨子宫动脉化疗栓塞治疗完全性胎盘植入的疗效和安全性。方法:选择2009年1月至2014年10月由外院转至本院或在本院经阴道分娩及引产后诊断为完全性胎盘植入的患者25例为治疗组,行双侧子宫动脉分别灌注MTX50 mg后再予以明胶海绵颗粒栓塞双侧子宫动脉。同时选择2005年3月至2009年3月由外院转至本院或在本院经阴道分娩及引产后诊断为完全性胎盘植入患者18例为对照组,采用全身化疗。观察两组治疗后阴道流血情况,血β-HCG变化,胎盘排出或清宫时间及次数,治疗后月经恢复时间及有无宫腔感染和粘连。结果:治疗组25例患者子宫动脉化疗栓塞均一次性成功,23例成功保留子宫,2例因严重感染无法控制切除子宫;对照组18例,有2例因严重宫腔感染,4例阴道大出血行子宫切除术;治疗组阴道流血量、血β-HCG下降至正常时间、胎盘排除时间、清宫次数、治疗副反应、宫腔感染及宫腔黏连明显低于对照组,两组比较具有统计学意义(P<0.05)。治疗组随访20例,对照组随访10例,两组月经来潮时间无显著差异(P>0.05)。结论:子宫动脉化疗栓塞治疗完全性胎盘植入具有出血少,治疗时间短,并发症少且能保留子宫,对患者生活质量影响小优点。

The clinical application of uterine artery chemoembolization in complete placenta increta

Objective:To investigate the clinical efficacy and security of bilateral uterine artery chemoembolization in complete placenta increta.Methods:Between January 2009 and October 2014,25 cases of complete placenta increta after vaginal delivery or in-duction were recruited in treatment group,bilateral uterine artery chemoembolization were administered.Between March 2005 and March 2009,18 cases of complete placenta increta in Affiliated Hospital of North Sichuan Medical College were recruited in control group,sys-temic chemotherapy were administered.We consider blood bleeding volume,range of HCG,time of placenta spontaneously discharged or abortion,time of regular menstruation returned,absence of intrauterine infection and adhesion.Results:In treatment group,bilateral u-terine artery chemoembolization was completed successfully once in 100% of these 25 cases,23 cases reserved their uterus,hysterecto-my were carried out because of severely infection in 2 cases.In control group,12 cases reserved their uterus,hysterectomy were carried out because of severely infection in 2 cases and blood bleeding in 4 cases.Blood bleeding volume,time of HCG return,time of placenta discharged,number of abortion,adverse effect,intrauterine infection and adhesion in treatment group were better than those in control group (P<0.05).Time of regular menstruation returned once more in 20 cases in treatment group were no significant difference than those in 10 cases in control group (P>0.05 ).Conclusion:Uterine artery chemoembolization is hemostatic procedure in treatment of complete placenta increta,and makes the preservation of uterus possible.