子宫动脉化疗栓塞术对子宫切口妊娠的治疗价值.docVIP

精品论文 参考文献 子宫动脉化疗栓塞术对子宫切口妊娠的治疗价值 伍中华 方向军 谭太发（南华大学附属第二医院放射科 421001） 【中图分类号】R713【文献标识码】A【文章编号】1672-5085（2012）6-0228-02 【摘要】目的 探讨子宫动脉化疗栓塞术对子宫切口妊娠的应用价值。方法 对127 例子宫切口妊娠患者行双侧子宫动脉超选择性插管，注入甲氨喋呤(MTX)100mg 后,用适量明胶海绵颗粒进行栓塞,24-48小时内行清宫术。结果 127例患者双侧子宫动脉插管均成功，实施了子宫动脉化疗栓塞术。24-48小时内行清宫术，术中出血量15-100ml。结论 子宫动脉化疗栓塞术降低了子宫切口妊娠患者保守治疗的风险，是一种安全、有效的治疗方法。 【关键词】子宫动脉 化疗栓塞 剖宫产切口妊娠 Application of Chemotherapy and Embolization of Pregnancy at the Uterine Incision after Cesarean Section 【Abstract】 Objective: To study the value of chemotherapy and embolization of pregnancy located at the uterine incision after cesarean sectionm Methods:mergency bilateral super selective uterine artery catheterization was performed in 127 patients with pregnancy located at the uterine incision after cesarean section. after infusion of methotrexate(MTX)and gelatin sponge granules were injected for embolization .curettage or uterine aspiration was carried out within 24-48 hours afterwards Results: Transuterine artery chemotherapy and embolization in combination with curettage or uterine aspiration were successfully carried out in all of the 127 cases with minimal bleeding during the operationm Conclusion: Chemotherapy and embolization in combination with curettage or uterine aspiration provide a safe and mini invasive approach for the treatment of pregnancy located at the uterine incision after cesarean sectionm. 【Key words】hemoembolization ptherapeuticj Vngiographypdigital subtractionj Pregnancypectopic 子宫切口妊娠（caesarean　scar preg nancy，CSP）是指胚胎附着于剖宫产后子宫前壁切口瘢痕的部位，是一种特殊的异位妊娠。如未得到及时诊治，随着妊娠的进展，可导致子宫破裂、阴道大出血，甚至危及患者的生命，是一种非常危险的异位妊娠类型。近年来，随着剖宫产率的增高，切口妊娠的发生率也有所增加。目前对子宫切口妊娠的治疗有手术治疗及保守治疗两种方法。近年来，随着介入治疗的应用，保守治疗取得了良好的效果，我院对2008年至2011年确诊的127例CSＰ患者先进行双侧子宫动脉化疗栓塞术，然后再行清宫术，取得了良好的疗效，现将结果报告如下。 1 资料与方法 1.1　一般资料确诊CSP患者127例，年龄２2～40岁，平均26岁；孕次１～3次；停经时间４5～72ｄ，平均50ｄ；血beta;－人绒毛膜促性腺激素（beta;－ＨＣＧ）为1943.４～21309.７Ｕ／Ｌ。127例患者均有１-2次剖宫产史，剖宫产方式为子宫下段横切口，剖宫产术后时间为６个月～１1年。54例有不规则阴道流血，其中12例已发生了大出血；73例无阴道流血。Ｂ型超声提示瘢痕切口包块直径３～５ｃｍ。