血管内介入治疗在子宫异位妊娠治疗中的临床应用

目的评估血管内介入治疗在子宫异位妊娠治疗中的临床应用价值。方法回顾性分析122例子宫异位妊娠患者血管内介入治疗前后的临床资料,其中宫颈妊娠49例、峡部妊娠9例、瘢痕妊娠60例、宫角妊娠4例,所有患者均行经股动脉穿刺双侧子宫动脉甲氨蝶呤灌注联合明胶海绵颗粒栓塞治疗。结果 122例患者中,24例因异位妊娠清宫术后阴道大出血急诊行两侧子宫动脉化疗栓塞术,其中宫颈妊娠10例、峡部妊娠1例、瘢痕妊娠12例、宫角妊娠1例;余98例患者采用子宫动脉化疗栓塞序贯超声引导下清宫术治疗。所有存在阴道出血患者于介入术后均停止出血;介入术后序贯清宫术治疗的患者于清宫术中均未出现大出血并发症。1个月后复查,所有患者人绒毛膜促性腺激素(β-HCG)均完全降至正常水平。结论子宫动脉化疗栓塞术可用于子宫异位妊娠清宫术后大出血的急救治疗;子宫动脉化疗栓塞术序贯超声引导下清宫术可作为子宫异位妊娠治疗中的一种新策略。

Clinical Application of Endovascular Interventional Therapy in Treatment of Uterine Ectopic Pregnancy

Objective To evaluate the clinical value of the endovascular interventional therapy in the treatment of uterine ectopic pregnancy.Methods We retrospectively analyzed the clinical data of 122 patients with uterine ectopic pregnancy in our Interventional Radiology Department from January 2006 to April 2012.All the 122 patients,including 49 cases of cervical pregnancy,9 cases of isthmus pregnancy,60 cases of scar pregnancy and 4 cases of cornual pregnancy,were subjected to the treatment of bilateral uterine artery methotrexate(MTX)infusion combined with uterine artery embolization with gelatin sponge particles.Results In the 122 patients,24 patients including 10 cases of cervical pregnancy,1 case of isthmus pregnancy,12 cases of scar pregnancy and 1 case of cornual pregnancy underwent emergency bilateral uterine artery methotrexate infusion and uterine arterial embolization with massive vaginal bleeding after the curettage for ectopic pregnancy;the remaining 98 patients with ectopic pregnancy underwent the sequential ultrasound-guided uterine curettage after bilateral uterine artery chemoembolization(UACE).The active vaginal bleeding was prevented after UACE,and there was no severe vaginal bleeding complication in the sequential ultrasound-guided curettage process.The β-HCG levels in all patients were became normal after one month.Conclusion UACE could be considered as the first choice for the emergency treatment of postoperative hemorrhage after uterine ectopic pregnancy curettage.The sequential ultrasound-guided uterine curettage after UACE can be used as a new strategy for the treatment of uterine ectopic pregnancy.