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应用.docVIP

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应用【摘要】 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例患者行宫腔镜妊娠组织清除术，5例患者行B超监视下清宫术，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。? 【关键词】 子宫动脉栓塞术； 子宫瘢痕妊娠； 宫腔镜?? The effect of uterine artery embolization following hysteroscopy in the treatment of cesarean scar pregnancy ?LI Juan.The First People?s Hospital of Jining,Jining 272011,China?? 【Abstract】 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 (DC) with the guidance of ultrasonograpy;3 cases received another dose of MTX intramuscle injection.Results UAE was successfully completed in all 18 cases.The following procedures including hysteroscopy and DC 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 hysteroscopy and DC possible.UAE combined with hysteroscopy was a new,safe,effective, promising and minimally invasive therapy.? 【Key words】 Uterine artery embolization; Cesarean scar pregnancy; Hysteroscopy ?? 剖宫产术后子宫瘢痕妊娠（Cesarean scar pregnancy，CSP)是指受精卵着床、生长于前次剖宫产切口瘢痕处，是剖宫产远期并发症之一，也是一种少见而危险的异位妊娠。近年来，随着剖宫产率的显著上升，其发生率呈上升趋势，严重威胁患者的生命安全，但CSP的治疗仍是目前临床上非常棘手的问题。随着数字减影血管造影术（Digital substraction angiography, DSA）在临床的广泛应用，子宫动脉化疗灌注栓塞术也越来越多地应用于CSP的治疗中??［1~3 ］?。为探讨子宫动脉化疗灌注栓塞术联合宫腔镜治疗CSP的临床疗效，笔者所在医院对2007年1月~2010年12月间确诊为CSP的18例患者进行了双侧子宫动脉药物灌注栓塞术，术后1周内10例行宫腔镜妊娠组织清除术，5例行B超监视