宫颈妊娠18例临床分析

目的:探讨宫颈妊娠的早期诊断方法及甲氨蝶呤配伍米非司酮联合保守手术的治疗效果。方法:对1998年1月至2006年5月间在我科收治的18例宫颈妊娠病例进行回顾性分析。结果:初次就诊时B超检查明确诊断14例,另4例未做B超检查,误诊为难免流产及早孕。采取药物联合保守手术治疗18例,成功17例,另1例失败而行全子宫切除术。结论:B超检查对宫颈妊娠的早期诊断有重要价值,药物联合保守手术治疗是安全可靠的方法。     

宫颈妊娠5例分析

目的:对5例宫颈妊娠的诊断治疗进行分析探讨方法:回顾性分析5例宫颈妊娠病例,讨论其结局及介绍几种保守治疗的方法结果:2例明确诊断者用MTX+米非司酮并辅以中药保守治疗成功;3例误诊者清宫时阴道大量出血,2例行子宫动脉栓塞治疗、1例行宫颈纱布填塞后均再行MTX药物保守治疗成功。结论B超对宫颈妊娠的早期诊断有重要价值,早期确诊药物保守治疗、宫颈妊娠大出血时子宫动脉栓塞治疗避免了子宫切除,保全了患者的生育功能。     

剖宫产术后瘢痕处妊娠15例临床分析

目的:探讨剖宫产术后瘢痕处妊娠(CSP)的临床特点、诊断及治疗方法.方法:对15例CSP患者的临床资料进行回顾性分析.结果:15例患者均有剖宫产术后人工流产史,平均2.57±1.32次;除一般早期妊娠的临床表现外,13例(86.7%)有妊娠早期阴道少量不规则流血,3例(20.0%)有下腹隐痛;术前分别误诊为宫内早孕及(或)伴先兆流产7例,稽留流产4例,宫颈妊娠1例,侵蚀性葡萄胎1例,只有2例术前B超检查明确诊断,另13例是在人工流产或刮宫手术时大出血后B超检查明确诊断;15例中13例行甲氨蝶呤和(或)氟尿嘧啶全身或局部应用,配合米非司酮口服药物保守治疗,1例行子宫动脉栓塞(UAE)配合药物治疗,1例行子宫全切术.结论:CSP一般超声检查可确诊,应提高临床医生对CSP的认识;禁止刮宫,误行刮宫大出血时纱条压迫宫颈止血有效;甲氨蝶呤和(或)氟尿嘧啶全身或局部应用,配合米非司酮口服是有效、简便的治疗方法.     

宫颈妊娠及宫内孕合并宫颈妊娠的保守治疗

目的:探讨宫颈妊娠的病因、诊断及保守性治疗方法。方法:回顾分析我院1996年1月1日至2010年12月31日收治的宫颈妊娠及体外授精胚胎移植术后宫内孕合并宫颈妊娠患者36例,探讨宫颈妊娠保守治疗方式的选择,并随访患者术后情况。结果:29例单纯宫颈妊娠:6例外院误诊为"难免流产",误诊率20.69%;10例经阴道B超引导下宫颈妊娠囊局部穿刺+MTX注射治疗,6例行子宫动脉栓塞术,6例MTX肌内注射治疗,7例腰麻下宫腔镜检查宫颈妊娠清除手术。7例宫内孕合并宫颈妊娠:1例阴道B超引导下局部妊娠囊穿刺注入KCl 1ml,3例期待疗法后清除宫颈妊娠物,3例腹部B超引导下宫颈妊娠物清除术。结论:阴道彩超用于宫颈妊娠的早期诊断有较大的价值,术前应充分评估,制定个体化的治疗方案。宫内孕合并宫颈妊娠的患者在腹部B超监测下清除宫颈妊娠物是有效的治疗方式之一,但要及时手术并且加强抗感染治疗。     

剖宫产术后子宫切口瘢痕妊娠的临床治疗研究

目的:探讨剖宫产术后子宫切口瘢痕妊娠的临床治疗方法方法:选取2009年2月至2010年11月于我院就诊的剖宫产术后子宫切口瘢痕妊娠患者16例,其中4例患者服用甲氨蝶呤(MTX)+米非司酮行药物治疗,5例患者行行子宫病灶切除术,6例患者行子宫动脉栓塞术后行清宫术,1例行子宫全切术结果:行药物治疗的4例患者中3例保守治疗成功,1例后行子宫病灶切除术,行手术治疗的患者均治愈出院结论:药物治疗、子宫病灶切除术、子宫动脉栓塞+清宫术、子宫全切术治疗子宫切口瘢痕妊娠均有一定疗效,根据患者病情,选择适当的治疗方法,能改善患者病情,提高治愈率。     

子宫动静脉瘘致阴道大出血的临床分析

目的探讨子宫动静脉瘘致阴道大出血患者的临床特点、诊断与治疗方法以及预后。方法对我院1990年8月至2003年5月收治的15例子宫动静脉瘘患者的临床资料进行回顾性分析。结果本组患者都以异常阴道大量出血就诊,15例均合并剖宫产分娩史、多次刮宫史或妇科恶性肿瘤病史。彩色B超及选择性子宫动脉造影通常可以明确诊断。诊断性刮宫并不能起到有效治疗作用,反而会加重出血。15例患者中,14例接受子宫动脉栓塞术,其中11例(79％)栓塞治疗成功,栓塞术后无并发症发生。保守治疗成功的患者术后均能恢复正常月经,并有5例成功妊娠。结论子宫动静脉瘘是导致阴道大出血的少见却严重的原因之一,子宫动脉栓塞术是治疗子宫动静脉瘘出血有效的保守治疗方法,栓塞术后患者的子宫及卵巢功能并不受影响。     

剖宫产术后子宫瘢痕妊娠20例临床治疗分析

目的探讨剖宫产术后瘢痕妊娠的临床特点、早期诊断及治疗方法。方法对煤炭总医院2010年4月至2014年4月收治的20例剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)患者的临床资料进行回顾性分析。结果超声确诊19例,1例B超可疑葡萄胎清宫后确诊瘢痕妊娠。4例单纯行清宫术;13例甲氨蝶呤+米非司酮治疗后行清宫术;1例清宫+米非司酮;2例阴道大出血患者行子宫动脉栓塞止血,其中1例行清宫术,另1例行清宫后结合MRI检查明确病灶与膀胱的关系,行开腹子宫瘢痕妊娠病灶切除术加子宫修补术。结论有剖宫产史的妇女因停经就诊时,要常规行超声检查,结合MRI检查可进一步明确诊断。子宫动脉栓塞可以迅速止血,药物加清宫可作为治疗子宫瘢痕妊娠的主要方法,必要时行子宫瘢痕病灶切除加子宫修补等治疗措施。     

剖宫产术后子宫瘢痕妊娠39例临床分析

目的：探讨剖宫产术后子宫瘢痕妊娠（CSP）的临床特点、诊断和治疗方法。方法：回顾分析2005年4月至2012年6月我院收治的39例CSP患者的临床资料。结果：39例CSP患者均有剖宫产手术史,其中4例有2次剖宫产史。39例CSP患者中,16例误诊为宫内妊娠,其中10例行清宫术中发生阴道大出血伴失血性休克,5例行药物流产失败,复查阴超确诊;1例引产分娩过程中发生大出血,出血量超过3000ml,彩超提示胎盘植入瘢痕;其余23例结合病史及阴道彩超确诊。12例CSP患者行天花粉蛋白＋米非司酮杀胚治疗,9例成功,3例失败者行子宫动脉栓塞术,后行腹腔镜下局部病灶切除术＋子宫修补术。26例行子宫动脉介入及栓塞治疗,22例成功,4例未能吸出孕囊而行腹腔镜下病灶切除术。1例行子宫全切术。患者均痊愈出院。结论：剖宫产史及超声检查可为CSP的诊断提供重要依据。子宫动脉介入及栓塞治疗、花粉蛋白＋米非司酮是治疗CSP的安全有效的方法。     

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.     

剖宫产术后子宫瘢痕妊娠13例临床分析

目的探讨剖宫产术后子宫瘢痕妊娠（cesarean scar pregnancy，CSP）的诊断及治疗方法。方法对北京协和医院1994—2004年收治的13例CSP患者临床资料进行回顾性分析。结果13例患者中10例诊断为宫内早孕行人工流产或药物流产。6例刮宫术中或术后发生大量阴道出血伴失血性休克。13例均经超声检查明确诊断。10例行子宫动脉栓塞（uterine artery embolisation，UAE）的患者均迅速有效的控制了阴道出血并减少了术中出血，其中9例患者栓塞后联合药物、手术或期待治疗均成功的保留了生育功能，仅1例因合并子宫肌瘤要求行全子宫切除术；3例单纯甲氨蝶呤（MTX）保守治疗，2例成功，1例治疗失败行开腹局部病灶切除术。结论超声是诊断CSP的简便可靠方法。子宫动脉栓塞可以迅速止血，栓塞后联合药物或手术治疗是可选择的安全有效的治疗方法，单纯MTX保守治疗的安全性及有效性有待进一步观察。     

Uterine artery embolization in postabortion hemorrhage

OBJECTIVE: To summarize the efficacy of postabortion uterine artery embolization in cases of refractory hemorrhage. METHODS: Forty-two women were identified who had postabortion uterine artery embolization at San Francisco General Hospital between January 2000 and August 2007. Seven underwent embolization for hemorrhage caused by abnormal placentation. RESULTS: Embolization was successful in 90% (38 of 42) of cases. All failures (n=4) were in patients who had confirmed abnormal placentation. However, three of seven women (43%) with probable accreta diagnosed by ultrasonography were treated successfully with uterine artery embolization. Two patients experienced complications of uterine artery embolization. These complications-one contrast reaction and one femoral artery embolus-were treated without further sequelae. CONCLUSION: Uterine artery embolization is an alternative to hysterectomy in patients with postabortion hemorrhage refractory to conservative measures, especially when hemorrhage is caused by uterine atony or cervical laceration.     

Is uterine artery embolization for cervical ectopic pregnancy always safe?

The study objective was to assess the feasibility and the efficacy of bilateral uterine artery embolization (BUAE) for the treatment of cervical pregnancy. The design was a series of 3 cases of viable cervical pregnancy diagnosed by transvaginal ultrasonography and treated by means of BUAE and subsequent uterine curettage. Three women with viable cervical pregnancy underwent BUAE and subsequent uterine curettage in the department of obstetrics and gynecology, High Risk Pregnancy Center, University "Federico II" of Naples. Measurements included surgical outcomes and preservation of fertility. The treatment was effective in all cases. Two patients resumed normal menstruation about 1 month after the procedure, whereas 1 patient underwent a hysterectomy 2 weeks after embolization because of acute ischemic degeneration of a concomitant myoma. The conservative management of cervical pregnancy with angiographic BUAE is a feasible and effective option, even if subsequent hysterectomy may be required. Counseling is necessary.     

子宫下段妊娠人工流产术中大出血临床分析--附四例报告

目的 探讨早期子宫下段妊娠人工流产术中大出血的病例特点和保守治疗的方法。方法 回顾性分析1994年5月至2002年7月我们收治的4例子宫下段妊娠行人工流产术中大出血的病例资料。结果 4例患者均有剖宫产史;其中3例停经后有阴道不规则出血;子宫动脉造影显示子宫下段供血区出血;4例均于人工流产术中发生大出血,采用子宫动脉栓塞治疗,止血效果好。无一例因子宫动脉栓塞而行全子宫切除者。结论 有剖宫产史的患者再受孕时,有发生子宫下段妊娠的危险,行人工流产术中易发生难以控制的大出血;子宫动脉栓塞是行之有效的治疗方法。严格剖宫产指征和重视产后避孕,是主要的预防办法。     

Cervical pregnancy: a case series and a review of current clinical practice

Five consecutive cases of cervical pregnancy (CP) are presented. In four cases, the diagnosis was made at routine check-ups and these were all treated conservatively. In the fifth case, an erroneous diagnosis of inevitable abortion was made, in a patient presenting with profuse vaginal bleeding. Persistent bleeding following curettage required an emergency hysterectomy, after failure of compressive methods. From the four cases treated conservatively, three received standard methotrexate i.m. (MTX) in combination with bilateral uterine artery embolization (UAE). In one case MTX was followed by intraamniotic puncture and instillation of KCl due to persistent embryonic heartbeat. A spontaneous evacuation of the cervical pregnancy occurred in all patients treated conservatively. We postulate that the preventive use of uterine artery embolization in combination with standard MTX treatment could contribute to reduce the risk of excessive bleeding and facilitate spontaneous expulsion. Possible detrimental effects of the treatment on subsequent reproductive capacities and obstetrical outcome are also pointed out. The diagnostic methods and therapeutic approaches are discussed and the literature is reviewed. With referral to the first case of our series, which required an emergency hysterectomy, we want to stress the importance of an early diagnosis for a correct management of this condition.     

Cervical pregnancy: A case series and a review of current clinical practice

Five consecutive cases of cervical pregnancy (CP) are presented. In four cases, the diagnosis was made at routine check-ups and these were all treated conservatively. In the fifth case, an erroneous diagnosis of inevitable abortion was made, in a patient presenting with profuse vaginal bleeding. Persistent bleeding following curettage required an emergency hysterectomy, after failure of compressive methods. From the four cases treated conservatively, three received standard methotrexate i.m. (MTX) in combination with bilateral uterine artery embolization (UAE). In one case MTX was followed by intraamniotic puncture and instillation of KCl due to persistent embryonic heartbeat. A spontaneous evacuation of the cervical pregnancy occurred in all patients treated conservatively. We postulate that the preventive use of uterine artery embolization in combination with standard MTX treatment could contribute to reduce the risk of excessive bleeding and facilitate spontaneous expulsion. Possible detrimental effects of the treatment on subsequent reproductive capacities and obstetrical outcome are also pointed out. The diagnostic methods and therapeutic approaches are discussed and the literature is reviewed. With referral to the first case of our series, which required an emergency hysterectomy, we want to stress the importance of an early diagnosis for a correct management of this condition.     

介入治疗83例剖宫产瘢痕部妊娠临床效果分析

目的:评价介入治疗对剖宫产瘢痕部妊娠的临床效果。方法:回顾性分析83例因剖宫产子宫瘢痕部妊娠(CSP)行双侧子宫动脉化疗栓塞术介入治疗(UAE治疗)的临床效果。结果:①83例CSP患者术前B超诊断:早孕胚胎继续发育型52例;早孕胚胎停止发育型27例;流产出血型4例。经UAE后,79例在术后24~48 h行刮宫术,妊娠终止,术后1~2个月转经。3例继续妊娠,改用其他方法治疗;1例流产不全后子宫大出血,改行开腹手术。②术前胚胎继续发育型者52例,经UAE治疗后48 h复查B超,胎心消失49例,胚胎灭活率为94.23%,3例仍然存活,占5.77%;胚胎早期停止发育型和流产出血型共31例全部妊娠终止。结论:UAE治疗是治疗CSP可靠、有效的方法,但对胚胎继续发育型的CSP有治疗失败的风险。     

Complete abortion of a nonviable cervical pregnancy following methotrexate treatment

Cervical pregnancy is an uncommon ectopic pregnancy that accounts for approximately <1% of extrauterine gestations. This condition is associated with an extremely high risk of massive hemorrhage and previously often required hysterectomy. Current early ultrasonographic diagnosis and medical management in conjunction with other conservative measures, which include uterine artery embolization and intracervical balloon tamponade, have enabled conservation of the uterus. A young nulliparous patient ultrasonographically diagnosed with a cervical pregnancy and early fetal demise at 11 and 4/7 weeks gestation was managed with high-dose methotrexate and folinic acid rescue treatment. On the second day after treatment was initiated she spontaneously passed an intact gestational sac accompanied by minimal hemorrhage. Treatment was continued, with decreasing serum beta subunit of human chorionic gonadotropin levels and subsiding hemorrhage. Subsequent surgical measures were not required. This case suggests that complete abortion of a cervical pregnancy not necessitating surgical measures can occur.     

Uterine artery embolization in the treatment and prevention of postpartum hemorrhage.

OBJECTIVES: The study was conducted to evaluate the efficacy of superselective transcatheter uterine artery embolization for control of obstetric hemorrhage. METHODS: Between January 2002 and December 2005, 14 consecutive patients underwent uterine artery embolization to control postpartum hemorrhage, and two to prevent hemorrhage before second-trimester therapeutic abortion. RESULTS: Embolization was performed by transfemoral arterial catheterization. Pieces of absorbable gelatin sponge were used in all cases, with the addition of platinum coils in two cases for complete vessel occlusion. Optimal bleeding control was achieved in all cases but one--a patient who underwent hysterectomy due to embolization failure. No severe complications were observed. CONCLUSIONS: The high success rate, low morbidity rate, and possibility of preserving reproductive function have made superselective uterine artery embolization the technique of choice to control life-threatening, intractable postpartum hemorrhage in hemodynamically stable patients, provided multidisciplinary medical teams are promptly available.     

Cost analysis of myomectomy,hysterectomy, and uterine artery embolization

OBJECTIVE: The purpose of this study was to compare inpatient hospital costs of different treatments of uterine fibroid tumors, including myomectomy, hysterectomy, and uterine artery embolization in a teaching hospital. STUDY DESIGN: We reviewed the hospital database of 545 women with uterine fibroid tumors who were treated with abdominal myomectomy, total abdominal hysterectomy, vaginal hysterectomy, and uterine artery embolization between April 1997 and October 2001. RESULTS: Women who underwent hysterectomies and uterine artery embolization were significantly older than the women who underwent myomectomy. Uterine artery embolization was associated with the shortest hospital stay, although the hospital stay in the vaginal hysterectomy group was shorter than in the abdominal myomectomy and the total abdominal hysterectomy groups. Compared with other groups, the inpatient cost of nursing in the uterine artery embolization group was the lowest. The total inpatient cost of uterine artery embolization ($1,007.44 +/- $60.65 [Canadian dollars]) was significantly lower than the cost of total abdominal hysterectomy ($1,933.37 +/- $47.68 [Canadian dollars]), abdominal myomectomy ($1,781.73 +/- $47.16 [Canadian dollars]), and vaginal hysterectomy ($1,515.39 +/- $66.72 [Canadian dollars]; P <.001). Sixteen of the 85 patients (18.8%) were hospitalized after uterine artery embolization, mainly for abdominal pain. CONCLUSION: Compared with abdominal myomectomy, abdominal hysterectomy, and vaginal hysterectomy, uterine artery embolization is associated with a lower hospital cost and a shorter hospital stay. Hospitalization after uterine artery embolization is mainly for abdominal pain after the procedure. A better method of pain control to reduce the rate of hospitalization and its cost is needed.     

选择性动脉栓塞治疗妇产科大出血的临床应用

目的 研究选择性髂内动脉栓塞或子宫动脉栓塞技术在妇产科大出血中的临床应用。方法 选择性双侧髂内动脉或子宫动脉栓塞术治疗19例妇产科大出血患者，其中产后出血12例，功血3例，人工流产术后宫内残留2例，侵蚀性葡萄胎1例，绒癌子宫穿孔1例。产后出血、功血、宫内残留患者用明胶海绵栓塞，肿瘤患者用化疗药物加碘油混悬液、明胶海绵栓塞。结果 19例妇产科大出血患者栓塞后立即止血或出血明显减少，除1例出现右髂外动脉血栓形成，行右股动脉切开取栓术后好转外，余无严重并发症。结论 髂内动脉或子宫动脉栓塞技术的开展既避免了开腹手术，又不影响患者脏器功能，保留了年轻患者的生育功能，对抢救妇产科大出血是安全有效的。