【摘要】 目的:探讨子宫疤痕妊娠刮宫术前行经导管子宫动脉药物灌注及栓塞术(Uterine artery chem-emboli-zation,UACE)疗效、价值及副反应。材料与方法:本组病例共18例,经临床、超声确诊为子宫疤痕妊娠,采用经导管双侧子宫动脉内灌注甲氨喋呤每侧各25mg,然后予以明胶海绵颗粒栓塞双侧子宫动脉。结果:子宫动脉插管成功率100%,所有病例第3～7天行刮宫术,术中出血量约30～80ml,平均约60ml,刮宫组织均送病理活检,病理可见大量坏死的绒毛组织。出院后1个月、3个月随访,B超示子宫正常大小,均未见异常回声及异常血流信号,2～3月时月经恢复正常。本组18例并发症主要是不同程度的下腹痛,12例出现恶心、呕吐等胃肠道反应,7例出现低热,均经对症治疗后好转。结论:刮宫术前行经导管子宫动脉药物灌注及栓塞术治疗子宫疤痕妊娠具有安全、有效、保留生育功能、并发症少特点,应作为一种术前常规治疗方法。更多还原

【Abstract】 Purpose:To evaluate the effect,value and complications with transcatheter uterine artery chem-embolization(UACE) before curettage in a cesarean scar pregnancy(CSP).Materials and Methods:18 patients with CSP were assumed by clinical color Doppler ultrasound.By using Seldinger technique,the bilateral uterine arteries were embolized with Gelfoam particles after irrigating with 25mg methotrexate(MTX) each side.Results:The successful rate of catheterization was 100%.18 cases who were treated with UACE had bleeding 30 ～ 80ml(an average of 60ml) during curettage within 3 ～ 7 days.The necrotic villus was found in the tissue from curettage by pathologic examination.1 to 3 months follow-up after discharge showed normal size uterus,no abnormal echo signal and blood signal was not found by color Doppler.18 patients recovered normal menstruation after 2 ～ 3months.The complications,which recovered after therapy,were various degrees of low abdominal pain in 18 cases,nausea and vomitting in 12 cases and low ferver in 7 cases.Conclusion:UACE is a safe,effective method with fertility preservation and few complications,which should be the conventional choice for patients with CSP before curettage.更多还原