子宫动脉栓塞术联合宫腔镜在剖宫产术后子宫瘢痕妊娠中的应用

目的探讨子宫动脉化疗灌注栓塞术联合宫腔镜治疗剖宫产术后子宫瘢痕妊娠的临床疗效。方法对18例剖宫产术后子宫瘢痕妊娠患者行双侧子宫动脉选择插管，灌注甲氨蝶呤后应用明胶海绵颗粒栓塞，术后1周内10例患者行官腔镜妊娠组织清除术，5例患者行B超监视下清官术，3例患者行甲氨蝶呤肌注治疗。结果18例患者均一次成功施行子宫动脉栓塞术，术后1周内顺利行宫腔镜手术或清宫术，术中出血量少，术后1—3个月均恢复正常月经，2例患者正常宫内妊娠。结论子宫动脉栓塞术对剖宫产术后子宫瘢痕妊娠止血疗效确切，为宫腔镜治疗提供安全保障，二者联合应用是一种新型、安全有效、微创的保守治疗方法，值得推广应用。

The effect of uterine artery embolization following hysteroscopy in the treatment of cesarean scar pregnancy

Objective To evalulate the clinical effect of uterine artery embolization （UAE） following hysteroscopy in the treatment of cesarean scar pregnancy （ CSP）. Methods UAE was preformed by seldinger technique and methotrexate （MTX） artery chemotherapy was administed to 18 cases with CSP, within one week of UAE, 10 cases had their pregnancy products removed by hysteroscopy;5 cases underwent dilation and curettage （D＆C） with the guidance of ultrasonograpy;3 ca- ses received another dose of MTX intramuscle injection. Results UAE was successfully completed in all 18 cases. The follow- ing procedures including hysteroscopy and D＆C within one week after UAE were safely with little bleeding. The menstruation recovered 1- 3 month after UAE,2 patients had normal intrauterine. Conclusion UAE may stop bleeding of CSP with definite effect, which may make furter conservative treatment including hysteroseopy and D＆C possible. UAE combined with hysteroscopy was a new, safe,effective, promising and minimally invasive therapy.