子宫动脉栓塞术在子宫瘢痕妊娠中的临床应用

目的：探讨子宫动脉栓塞术在子宫瘢痕妊娠（cesarean scar pregnancy，CSP）的诊断及治疗效果分析。方法：对1998-2006年收治的11例CSP患者临床资料进行回顾性分析。结果：11例患者中5例在盆腔B-超初筛及阴道多普勒复核确诊，先行子宫动脉栓塞（uterine artery embolisation，UAE）后行人流术，有4例一次治疗成功。6例诊断为宫内早孕行人工流产或药物流产，在流产术中或术后发生大量阴道出血伴早期失血性休克，经复查彩超明确诊断，在UAE治疗后行清宫术成功，均迅速有效的控制了阴道出血并减少了术中出血，7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有6例。结论：子宫动脉栓塞可以迅速止血，应首选，栓塞后联合药物或联合B超监视宫腔镜下清宫以及手术治疗是安全有效的治疗方法。

Clinical value of uterine arterial embolization of cesarean scar ectopic pregnancies

Objective： To clinical value of uterine arterial embolization cesarean scar preguancy（CSP）. Methods： there were 1 leases CSP in our hospital from 1998 to 2006, clinical data analyzed retrospectively. Results： 5 cases were preliminary screened through ultrasonography and final diagnosised through vaginal color Doppler, in these, 4 cases got success through playing induced abortion after embolizing uterine artery. Another 6 eases were occurred vaginal bleeding and early hemorrhagic shock when were playi0g induced abortion or over, because misdiagnosised pregnancy in uterine, and final diagnosised through color Doppler. Among the 6 cases, 2 cases got success in induced abortion after UAE, 4 cases treated by using MTX, 1 case succeed in MTX, 2 eases succeed in MTX and removed residual under hysteroscope, 1 case played subtotal hysterectomy because vaginal bleeding after treated 1 course by MTX.In the 11 cases, there were 7 cases embolized uterine artery, the fertility of 6 eases were preserved, while that of 1 case was not preserved because of subtotal hysterectomy. Conclusion： there are reliable means preliminary screened through nltrasonography and final diagnosised through vaginal color Doppler in diagnosing CSP early.And UAE plays an important role in all the treatments for CSP.Combine UAE with MTX, or combine UAE with induced abortion under hysteroscope, or subtotal hysterectomy were safe and effective, the curative effect is uncertainty if use MTX only.