子宫动脉灌注化疗栓塞联合宫腔镜电切术治疗子宫切口妊娠的临床价值

目的:探讨子宫动脉灌注化疗栓塞联合宫腔镜下电切术治疗子宫切口妊娠的临床价值。方法:回顾性分析20例子宫切口妊娠患者的资料,均行双侧子宫动脉灌注氨甲蝶呤(MTX),并使用明胶海绵粉和颗粒栓塞子宫动脉,栓塞术后24 h观察血人绒毛膜促性腺激素(β-HCG)值与手术前变化,第7天实施宫腔镜下电切术。结果:20例患者双侧子宫动脉插管成功率100%。造影后经导管注入化疗药物及栓塞剂栓塞双侧子宫动脉,术后无严重并发症,术后24 h血β-HCG与术前比较明显下降,术后第7天行宫腔镜下电切术,出血量少,在10～30 ml之间。结论:子宫动脉灌注化疗栓塞联合宫腔镜电切术可有效地杀死胚囊,易于切除胚胎组织,防止发生致命性大出血,缩短病程,保全了患者的生育能力和生命安全。

Clinical value of uterine artery chemoembolization combined with hysteroscopic electrocision for treatment of cesarean scar pregnancy

Objective:To explore the clinical value of uterine artery chemoembolization combined with hysteroscopic electrocision for treatment of cesarean scar pregnancy(CSP).Methods:The data of 20 patients with CSP were analyzed retrospectively,all the patients were treated with bilateral uterine artery perfusion of methotrexate(MTX),the uterine arteries were embolized with gelfoam powder and particles,the change of blood β-human chorionic gonadotropin(β-HCG) value at 24 hours after embolism was observed,hysteroscopic electrocision was performed on the seven day after embolism.Results:The successful rate of bilateral uterine artery intubation in the 20 patients was 100%;after radiography,the chemotherapeutic drugs and embolizing agents were injected by tubes to embolize bilateral uterine arteries,no severe complications occurred after operation;the blood β-HCG value at 24 hours after embolism was statistically significantly lower than that before embolism;hysteroscopic electrocision was performed on the seven day after embolism,the volume of blood loss was 10-30 ml.Conclusion:Uterine artery chemoembolization combined with hysteroscopic electrocision can kill blastosphere effectively,excise embryonic tissue easily,prevent fatal hemorrhage,shorten the course of disease,and reserve reproductive ability and life safety of the patients.