【摘要】 目的 探討雙側(cè)子宮動脈化療栓塞術(shù)治療剖宮產(chǎn)子宮切口妊娠的臨床應用價值。 方法 2004年3月-2009年10月確診剖宮產(chǎn)子宮切口妊娠的患者25例。首先行雙側(cè)子宮動脈超選擇插管，注入甲氨喋嶺，再用明膠海綿條栓塞雙側(cè)子宮動脈，48~72 h內(nèi)在B型超聲監(jiān)測下行清宮術(shù)。 結(jié)果 25例子宮動脈化療栓塞術(shù)后復查B型超聲，提示孕囊血供明顯減少。22例在B型超聲監(jiān)測下一次性清除胚胎組織，出血量少；2例因胚胎植入肌層突向漿膜層栓塞術(shù)后加用氟尿嘧啶，未行清宮，自行排出；1例因術(shù)后切口處形成大血腫行手術(shù)治療。 結(jié)論 雙側(cè)子宮動脈化療栓塞術(shù)是治療剖宮產(chǎn)子宮切口妊娠一種有效方法，既保留子宮，又保留其生育功能。
【Abstract】 Objective To evaluate the application of bilateral uterine artery chemoembolization for caesarean scar pregnancy (CSP）. Methods A total of 25 patients with CSP From March 2004 to October 2009 were selected. Bilateral uterine artery super selective catheterization was performed after injection with methotrexate, and gelatin sponge granules were injected into blateral uterine artery. Then atificial abortion was performed under B-ultrasonic scanning within 48-72 hours. Results In all 25 cases, the blood flow of the embryo decreased significantly after uterine artery chemoembolization. A total of 22 patients received artificial abortion successfully with little vaginal bleeding;two pateints received medication with 5-FU duet to the embryo near to the perimetrium, and finally the embryo expulsed spontaneously;one patient underwent hysterectomy, because a huge hematoma was formed at the incision of the uterus after uterine artery chemoembolization. Conclusion Bilateral uterine artery chemoembolization is effective for CSP, which could keep the uterus and the patients’ reproductive function.
引用本文： 范波,敬巧,黃錦. 雙側(cè)子宮動脈化療栓塞術(shù)治療剖宮產(chǎn)子宮切口妊娠. 華西醫(yī)學, 2010, 25(9): 1649-1650. doi: 復制
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- 1. Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnencies [J]. Obstet Gynecol, 2006, 107(6): 1373-1381.
- 2. Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar [J]. Ultrasound Obstet Gynecol, 2000, 16(6): 592-593.
- 3. 張桂蘭, 周留林. 子宮瘢痕處早期妊娠8例治療體會[J]. 醫(yī)學理論與實踐, 2008, 21(12): 1444-1445.
- 4. 高桂芹. 剖宮產(chǎn)子宮瘢痕妊娠的診斷與治療進展[J]. 國際婦產(chǎn)科學雜志, 2008, 35(1): 15-18.
- 5. Roberts H, Kohlenber C, Lanzarone V, et al. Ectopic pregnancy in lower segment uterine scar[J]. Aust NZ J Obstet Gynecol, 1998, 38(1): 114-116.
- 6. Flystra DL, Pound-Chang T, Miller MG, et al. Ectopic pregnancy within a cesarean delivery scar areviem[J]. Obstet Gynecol Surv, 2002, 57(8): 537-543.
- 7. 范光升, 劉欣艷, 金力, 等. 介入技術(shù)在終止剖宮產(chǎn)后子宮下段瘢痕早期妊娠的應用[J]. 中國計劃生育學雜志, 2005, 119(9): 545-546.