子宫动脉灌注化疗及栓塞在治疗剖宫产切口瘢痕妊娠中的应用价值

目的探讨经子宫动脉灌注化疗及栓塞术治疗剖宫产切口瘢痕妊娠的应用价值。方法 23例剖宫产后切口瘢痕妊娠病例,在DSA引导下经双侧子宫动脉按血供比例分配灌注甲氨蝶呤100mg进行灌注杀胚,再以明胶海绵栓塞,术后24～48h行清宫术。结果全部病例均顺利完成双侧子宫动脉灌注化疗及栓塞术,术后24h复查血清β-HCG水平较术前平均下降87.77%,阴道出血停止,清宫术中出血10～200ml,平均40ml,无严重并发症发生。结论经子宫动脉灌注可明显提高胚囊局部甲氨蝶呤的血药浓度,有效杀伤和消除胚胎组织,栓塞后阻断胚胎血供,达到降低子宫切除和丧失生育能力的风险,缩短住院时间,是治疗剖宫产切口瘢痕妊娠安全、有效的方法。

The application of uterine arterial infusion chemotherapy and embolization in treating cesarean scar pregnancy

Objective To explore the effectiveness of uterine artery chemoembolization in the treatment of cesarean scar pregnancy.Methods 23 consecutively enrolled patients with cesarean scar pregnancy accepted methotrexate（100mg） by via bilateral uterine arteries according to blood supply,and followed by embolization with gelfoam.Curettage of uterus was carried out in 24～48 hours after the procedure.Results All the cases completed bilateral uterine artery chemoembolization successfully,the level of β-HCG reduced 87.77% in 24 hours after operation compared with preoperative,vaginal hemorrhage stopped,blood loss was 10～200ml（average 40ml）during uterine curettage,and with no serious complication.Conclusion Intra-arterial chemoembolism could elevate the blood drug level of methotrexate in embryonic sac and obstruct fetal blood obviously,kill and wound embryonic tissue effectually.The uterectomy and loss of potentia generandi were decreased.Uterine arterial infusion chemotherapy and embolization is safe and effective in the treatment of cesarean scar pregnancy.