子宫动脉化学治疗栓塞术在剖宫产术后子宫瘢痕处妊娠治疗中的应用

目的:探讨子宫动脉化学治疗栓塞术(UACE)治疗剖宫产术后子宫瘢痕处妊娠(CSP)的临床价值。方法:对15例CSP患者行UACE治疗,先经双侧子宫动脉灌注甲氨蝶呤50～100 mg,再以明胶海绵栓塞,术后短期内行清宫术或宫腔镜病灶电切术或局部注射甲氨蝶呤治疗。结果:15例CSP患者均成功施行UACE。因阴道大量流血行紧急UACE 4例,均成功止血。UACE联合清宫术6例,其中清宫距UACE 2～7 d 5例,术中出血少;UACE后12 d清宫1例,术中出血150 ml。UACE联合宫腔镜下病灶电切术5例,其中宫腔镜手术距UACE 2～7 d 4例,术中出血少;UACE后2周行宫腔镜病灶电切术1例,术中出血较多,中转开腹行病灶切除加修补术。UACE后行局部注射甲氨蝶呤3例。1例单纯行UACE。15例CSP患者均治愈,无子宫切除病例。结论:UACE可有效、迅速止血,并可预防出血,为宫腔镜手术或清宫术等后续治疗增加了安全性,在CSP治疗中具有重要地位。

Application of uterine chemoembolization in treating cesarean scar pregnancy

Objective： To investigate the clinical significance of uterine artery chemoembolization （UACE） in the treatment of cesarean scar pregnancy （CSP）. Methods： UACE, which was performed via bilateral uterine ar- tery infusion of MTX （50- 100 mg） and subsequent uterine artery embolization with Gelfoam, was carried out in 15 patients with CSP. Curettage, hysteroscopy electro-resection or MTX local injection was carded out after UACE. Results： UACE were successfully performed in all 15 patients with CSP. Emergent UACE was performed success- fully in 4 cases due to excessive vaginal bleeding. Curettage was carded out in 6 cases after UACE. Blood loss dur- ing the curettage procedure was mild except for one case. Hysteroscopy electro-resection was carded out in 5 cases. Blood loss during the operation was mild except for one with complicated excessive bleeding during operation, re- quiring local resection and uterine repair by laparotomy. Local MTX injection was carded out in 3 cases after UACE. Fifteen patients were successfully cured requiring no hysterectomy. Conclusion： UACE can improve the safety of curettage and hysteroscopy electro-resection.