应用子宫动脉栓塞术治疗剖宫产瘢痕处妊娠

目的 通过与药物(MTX)治疗方法比较,评价子宫动脉栓塞术治疗剖宫产瘢痕处妊娠的疗效和安全性.方法 将60例子宫剖宫产瘢痕处妊娠妇女分成药物组31例,栓塞组29例,观察其出血量、副反应、住院时间和随访月经恢复情况.结果 栓塞组无子宫切除者,药物组2例;副反应:栓塞组主要是栓塞后综合征:发热15例,轻度下腹酸胀痛、臀部疼痛、右下肢麻木等不适10例.药物组主要出现肝功能轻度异常7例,胃肠道反应8例;住院时间:栓塞组(14.4±1.7)d,药物组(39.3±4.7)d,差异有统计学意义(P<0.05).保留子宫者两组术后1～2个月,月经均恢复正常.结论 子宫动脉栓塞术治疗子宫剖宫产瘢痕处妊娠具有降低大出血风险,保留妇女生育功能,住院时间短和副反应轻的优点,是安全、有效的治疗方法.

Treatment of pregnancy in a previous caesarean section scar with uterine artery embolization: analysis of 60 cases

Objective To evaluate the security and effectiveness of uterine artery embolization (UAE) in treatment of pregnancy in uterine caesarean scar compared with medicine treatment. Methods Sixty patients with pregnancies in uterine caesarean scar were divided into medicine group ( n = 31 ) that received intravenous injection of methotrexate (MTX) 100 mg once or MTX 20 mg once a day for 5 days as the first course, received the second course when the serum 13-human chorionic gonadotropin (HCG) decreased to the level as < 50%, and then underwent uterine curettage; and UAE group (n = 29) that underwent catheterization into the left uterine artery and then uterine curettage 48h after the successful embolization. The bleeding volume during suction curettage, side effects, admission day, and menstruation recover time were recorded. Results The hospital stay of the UAE group was ( 14.4±1.67 ) days, significantly shorter than that of the medicine group (39.3±4.71 ) days, P<0.05]. No patient had to receive hysterectomy in the UAE group but 2 in the medicine group underwent hysterectomy. Seven patients showed liver dysfunction and 8 patients had nausea and slight vomit in the medicine group, and 15 patients with fever and 10 with light post-embolization syndromes were found in the UAE group. Menstruation resumed normal in all patients of the 2 groups one or two months later. Conclusion With the advantage of low risk of heavy bleeding and shorter admission day, UAE is safe and effective in treatment of pregnancy in uterine caesarean scar.