栓塞子宫动脉治疗宫颈妊娠1例

患者 2 2岁 ,住院号 16 4 6 4 6 ,因阴道大出血 1天于 2 0 0 1年 12月 17日急诊入院。患者平素月经周期 1～ 2月不等 ,末次月经 2 0 0 1年 9月 17日 ,停经后无恶心、乏力等不适感 ;12月 16日中午开始阴道流血 ,以为月经来潮 ,夜间开始血量增多 ,伴大血块排出 ,小腹隐痛、出冷汗、头昏等 ;入院查体 :BP 14 / 8kPa ,P 96 /min ,心肺无异常 ,腹平软 ,无压痛及反跳痛 ,叩诊移动性浊音阴性 ;肛诊未作 ;予促宫缩、止血、对症处理同时急查血常规 :Hb10 9g/L ,尿妊娠试验阳性 ,B超提示 :宫体部大小基本正常 ,宫颈明显增大 ,形态饱满 ,内见一 4 9m…     

子宫动脉化疗灌注加栓塞在宫颈妊娠治疗中的应用

宫颈妊娠是指受精卵在宫颈管内种植,并在此处生长发育,在我院同期异位妊娠中发生率为0.86%.早期临床表现无特异性,B超可发现官颈管内异常回声,从而怀疑或诊断为宫颈妊娠,也可能被误诊为流产,冒然清宫可发生大出血.近年我院利用子宫动脉化疗灌注加栓塞,辅以清宫和MTX、米非司酮治疗宫颈妊娠取得了满意疗效,现报道如下.     

选择性子宫动脉栓塞治疗宫颈妊娠5例分析

宫颈妊娠临床一般采用保守治疗、化疗及手术治疗。我院自 1995年 9月至 1999年 12月采用经皮股动脉穿刺选择性子宫动脉栓塞成功治疗宫颈妊娠 5例 ,取得满意疗效 ,报道如下。1　资料与方法1 1　临床资料　选择 5例自愿接受动脉栓塞治疗的宫颈妊娠患者 ,年龄 2 431岁 ,其中 3例已生育子女 ,均有停经、阴道淋漓出血及不同程度的腹痛症状史 ,血 β -ｈＣＧ 2 30 989ｍＩＵ/Ｌ(放免法 )。1 2　方法　术前准备 :患者常规行血液分析、肝肾功能、心电图、胸透等检查。术前作普鲁卡因、碘过敏试验。　　操作方法 :患者经皮股动脉穿刺 ,放置 4Ｆ或 5…     

子宫动脉栓塞术在终止子宫瘢痕妊娠中的应用体会

本文分析了我院近3年来收治的11例剖宫产术后子宫下段瘢痕妊娠患者,均先采用双侧子宫动脉超选择性插管,灌注甲氨蝶呤（MTX）后用明胶海绵颗粒栓塞双侧子宫动脉,48h后在超声监视下行负压吸宫人工流产术,无一例发生大出血,全部保留了子宫,取得良好的治疗效果,现报告如下.[第一段]     

子宫动脉栓塞联合宫腔镜治疗剖宫产瘢痕妊娠41例临床分析

目的评价子宫动脉栓塞(UAE)联合宫腔镜治疗剖宫产瘢痕妊娠(CSP)的手术效果及结局。方法回顾性分析2005年1月至2012年6月北京大学人民医院住院行UAE联合宫腔镜手术的41例CSP患者的临床资料。结果 41例患者UAE术后均成功实施了宫腔镜手术,平均手术时间(26.0±13.1)min(10～60min),平均手术出血量(24.0±4.2)ml(20～30ml),平均住院天数(5.2±1.6)d(3～8d)。宫腔镜下见胎囊为外突型4例(9.7%),外突型平均手术时间[(42.5±17.1)min]显著低于内生型[(22.8±9.0)min;P=0.001];外突型平均孕周[(8.7±3.0)周]显著低于内生型[(6.7±1.7)周;P=0.041];二者β-hCG值、瘢痕厚度及血流阻力指数(RI)比较,差异均无统计学意义(P>0.05)。术后轻度发热者占9.7%(4/41)、轻至中度下腹痛者占24.4%(10/41)。随访率95.1%(39/41),术后平均血β-hCG值恢复时间(2.6±2.2)周(1～8周);平均月经恢复正常时间(4.4±1.3)周(4～12周)。其中1例患者2次栓塞术后出现闭经,经人工周期治疗术后6个月月经恢复。术后妊娠2例,1例为正常宫内妊娠,因计划外行人工流产术;1例再次发生剖宫产瘢痕妊娠,再次UAE+宫腔镜手术治疗。结论子宫动脉栓塞联合宫腔镜治疗剖宫产瘢痕妊娠是一个可靠的治疗选择,在保留了患者生育功能的同时,具有成功率高、并发症少、住院时间及血β-hCG值恢复时间短的优点。     

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。     

子宫动脉栓塞术治疗子宫颈妊娠的临床效果观察

宫颈妊娠是少见的异位妊娠，其发生率约为1／1000～1／18000次宫内妊娠，可导致致命性大出血，严重时须切除子宫。我院自2000年开始对宫颈妊娠患行子宫动脉栓塞术（uterine artery embolizmion，UAE）治疗，取得了较好疗效，现将结果报道如下。     

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.     

经导管子宫动脉灌注MTX栓塞治疗宫颈妊娠大出血1例

患者 ,30岁 ,因停经 72ｄ ,间断阴道流血 36ｄ伴下腹疼痛 3ｄ ,于 2 0 0 0年 6月 2 6日收住院。月经规律 ,孕5产1(7年前剖宫产一男婴 ) ,末次月经 2 0 0 0年 4月 14日。妇科检查见外阴发育正常 ,阴道已婚未产式 ,宫颈膨大、紫色 ,子宫前位、40 天孕大 ,活动、压痛 ,双附件正常 ,查尿ｈＣＧ( ) ,Ｂ超示子宫下端有 3.7ｃｍ× 4.3ｃｍ× 2 .3ｃｍ的混合性团块 ,宫腔内可见直径 1.6ｃｍ的液性暗带。诊断为“不全流产伴感染” ,抗炎治疗 3天后刮宫 ,刮出组织 15ｇ ,术中出血 30 0ｍｌ,予以宫缩剂 ,出血减少、停止。病检报告为蜕膜、未见绒毛。…     

药物预处理与子宫动脉栓塞术对宫腔镜下清宫术治疗剖宫产瘢痕妊娠疗效的影响

目的：探究药物预处理与子宫动脉栓塞术对宫腔镜下清宫术治疗剖宫产瘢痕妊娠（CSP）疗效的影响。方法：回顾性收集2016年1月-2017年11月河南省信阳市中心医院妇科收治的120例CSP患者的临床资料,根据治疗方法不同分为研究组72例、对照组48例,分别给予米非司酮+甲氨蝶呤（MTX）药物预处理（研究组）、子宫动脉栓塞术干预（对照组）,而后实施宫腔镜下清宫术。观察和统计所有患者手术完成情况、术后恢复进度及并发症发生情况。结果：2组患者的二次清宫、大出血、中转开腹、子宫切除发生率比较,差异无统计学意义（P＞0.05）。2组患者手术耗时、术中出血量比较,差异无统计学意义（P＞0.05）,但研究组术后住院时间、阴道出血时间、月经恢复时间及血人绒毛膜促性腺激素β亚单位（β-hCG）恢复时间较对照组缩短（P＜0.05）。研究组患者并发症以胃肠道反应为主,发生率为22.22%,高于对照组的7.14%（P＜0.05）;对照组并发症以发热、疼痛为主,发生率分别为18.75%、33.33%,高于研究组的2.78%、8.33%（P＜0.05）;此外,2组感染、肝功能受损、宫腔粘连、子宫穿孔发生率比较,差异无统计学意义（P＞0.05）。结论：宫腔镜下清宫术前给予米非司酮+MTX药物预处理有助于改善CSP患者的临床疗效,术后恢复快,并发症少,但仍应注意胃肠道反应等并发症的防治。     

Angiographic uterine artery embolization followed by immediate curettage: an efficient treatment for controlling heavy bleeding and avoiding recurrent bleeding in cervical pregnancy

Two cases of cervical pregnancy with heavy bleeding successfully treated by uterine artery embolization (UAE) followed by immediate curettage are described in this report. Case 1 demonstrated intermittent bleeding after serious bleeding was successfully controlled by UAE. Serum beta human chorionic gonadotropin (beta-hCG) level rose remarkably after a short time decline. Transvaginal sonography consistently revealed a heterogeneous mass in the cervix. Repeated UAE followed by immediate curettage was performed and complete resolution was achieved. Case 2 was also successfully managed by UAE followed by immediate curettage after failure of medical treatment. This report suggests that UAE followed by immediate curettage is a safe and efficient procedure for controlling heavy bleeding and avoiding recurrent bleeding when fertility capacity is desired in cases of cervical pregnancy with fetal cardiac activity and high beta-hCG concentration.     

子宫动脉栓塞治疗粘膜下子宫肌瘤的研究

目的探讨子宫动脉栓塞（uterine artery embolization，UAE）治疗粘膜下子宫肌瘤的疗效和转归。方法对我院2000年6月～2004年6月的41例单发粘膜下子宫肌瘤行UAE治疗的病例进行观察。结果①经MR检查确诊41例单发粘膜下子宫肌瘤的病例，行UAE治疗后随访时间为12～48个月，有31例（75．61％）肌瘤完全消失，7例肌瘤体积缩小93％，以上38例（92．68％）子宫体积恢复至正常大小，3例UAE治疗后6～12个月失访（失访率为7．32％）；②41例中有19例肌瘤经阴道完整排出，其中自然排出6例，钳夹协助排出的13例；有7例部分排出，全部为钳夹协助排出，排出时间为7天～12个月。有12例通过阴道分泌物和排液方式完全排出；③41例患者月经量和贫血明显改善，治疗后38例月经恢复正常，3例月经量过少，治疗后6个月血红蛋白恢复正常；④术前及术后的性激素测定没有差异P〉0．05；⑤UAE治疗后有1例妊娠40周顺产，产后胎盘部分植入引起产后出血再次UAE治疗成功。结论UAE治疗粘膜下子宫肌瘤效果显著而安全。     

Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection

OBJECTIVE: To determine the accuracy of differential diagnosis by team consultation of abortion in progression, low-lying implantation/cervicoisthmic pregnancy, and cervical pregnancy (CP) in patients referred for suspicion of abnormal implantation on the lower segment and cervix of the uterus and to determine the efficacy of endoscopic surgery with uterine artery blockade followed by cervical evacuation in the treatment of confirmed CP. DESIGN: Prospective observational study under multiple-clinic and multiple-hospital cooperation. SETTING: Tertiary clinical and academic medical center. PATIENT(S): Twenty-seven women with a tentative diagnosis of CP made at their primary gynecologists' offices from July 1999 to June 2003. INTERVENTION(S): Second-opinion ultrasound scanning with transabdominal and transvaginal approach and optional color Doppler use. For patients with confirmed CP, a new treatment modality with laparoscopy-assisted uterine artery ligation followed by hysteroscopic local endocervical resection to remove the ectopic pregnancy was employed. For patients with abortion in progression or low-lying implantation/cervicoisthmic pregnancy (non-CP) requiring termination, dilatation and curettage (D&C) was performed under transabdominal ultrasound guidance. MAIN OUTCOME MEASURE(S): Fulfillment of ultrasound-based diagnostic criteria and operative course, convalescence, and commencement of menstruation in those patients with confirmed CP. RESULT(S): Cervical pregnancy was diagnosed in six (22.2%) patients at 相似文献   

Hysteroscopy after uterine fibroid embolization in women of fertile age

AIM: Uterine artery embolization for fibroids is a controversial issue for women with incomplete reproductive plans. Ovarian failure and uterine infection are the most dreaded complications of this procedure. The purpose of the present study was to assess the types and the frequency of intrauterine abnormalities and the histological features of the endometrium after embolization. METHODS: Uterine artery embolization was performed on 51 women (average age 34.5 years) with intramural fibroid/s larger than 4 cm. Hysteroscopy and endometrial biopsy was performed from 3 to 9 months later in the luteal phase of the cycle. RESULTS: Despite all women having no major symptoms prior to hysteroscopy, only 19 (37%) had completely normal hysteroscopic findings. There was intrauterine protrusion of fibroid/s in 19 cases (37%), yellowish coloration of the endometrium in 14 (28%), intrauterine or cervical adhesions in seven (14%), and communication between the myoma and the uterine cavity in five cases (10%). A normal, functional endometrium was histologically verified in 44 women of 49 (90%) who could be evaluated. Regressive changes (necrosis or hyalinization) of leiomyoma or of indefinite origin were found in 17 patients and embolization particles in five, including one patient with microspheres inside the endometrial vessel. No case of Asherman syndrome or endometrial atrophy was observed. CONCLUSION: The frequency of abnormal hysteroscopic findings after embolization is surprisingly high. The clinical significance, reversibility, and impact on fertility of abnormal hysteroscopic findings after embolization remain unclear. Regardless, hysteroscopy should be strongly recommended to all patients after uterine fibroid embolization, prior to conception.     

腹腔镜下可逆性子宫动脉阻断联合宫腔镜下吸宫术在剖宫产疤痕妊娠治疗中的应用:附10例病例报告

目的:探讨经腹腔镜可逆性子宫动脉阻断联合宫腔镜下吸宫术在剖宫产疤痕妊娠治疗中的临床价值。方法:对确诊为剖宫产疤痕妊娠、采用腹腔镜可逆性子宫动脉阻断联合宫腔镜下吸宫术治疗的10例患者临床资料进行回顾性分析。结果:10例患者手术均顺利完成,无中转开腹,无术后并发症。手术时间65~120 min,平均86±4 min;术中出血量60~110 mL,平均85±7 mL。患者术后6~12 h离床活动;术后24 h检测血β-hCG下降幅度均超过50%;术后住院时间2~4 d,平均3 d;血β-hCG于术后2~4周降至正常范围。结论:腹腔镜可逆性子宫动脉阻断联合宫腔镜下吸宫术治疗剖宫产疤痕妊娠是一种安全、有效、损伤小、恢复快、相对微创的治疗方式,具有一定的推广意义。