经导管子宫动脉化疗栓塞术治疗子宫疤痕妊娠合并出血

目的探讨经导管子宫动脉化疗栓塞术（Uterine artery chem-embolization,UACE）治疗子宫疤痕妊娠合并出血的方法、疗效及并发症。方法本组20例,由临床、彩色多普勒超声确诊为子宫疤痕妊娠伴出血。采用Seldinger插管技术,经导管双侧子宫动脉内灌注甲氨喋呤各50mg,然后予明教海绵颗粒（350-560μm）栓塞双侧子宫动脉。结果插管成功率100%,栓塞后出血立即停止,其中3例在术后第4天妊娠组织自行脱落,复查彩超宫内异常回声团消失,彩色多普勒血流信号消失,未予清宫出院;15例第5-7天行清宫术,自行脱落组织及清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个月随访无阴道出血,彩超示子宫正常大小,均未见异常回声及血流信号。本组20例除存在不同程度的下腹痛外无一例严重并发症发生,经对症处理后恢复正常。结论经导管子宫动脉化疗栓塞术治疗子宫疤痕妊娠合并出血创伤小、疗效显著,是一种行之有效的治疗方法 。

Clinical Application of Transcatheter Uterine Artery Chem-Embolization for Bleeding in a Cesarean Scar Pregnancy

Objective To study the method,effect and complications of transcatheter uterine artery chem-embolization（UACE）for bleeding in a cesarean scar pregnancy（CSP）.Methods The diagnosis of 20 patients was assumed by clinical,color Doppler ultrasound.By using Seldinger technique,the bilateral uterine arteries were embolized with Gelfoam particles（350～560 μm）after irrigating with 50 mg methotrexate（MTX）each side.Results The successful rate of catheterization was 100%.The bleeding was immediately stopped after embolization.The pregnancy tissues of 3 cases fell off in the fourth day,the abnormal echo mass and blooding signals disappeared in color Doppler,and the patients were discharged without curettage.15 cases underwent curettage on day 5 to 7.The necrotic villus was found in the tissue from curettage and autotomy by pathologic examination.1 to 3 months follow-up showed no vaginal bleeding and normal size uterus,and abnormal echo signal and blood was not found by color Doppler.There was no serious complication,and the various degrees of abdominal pain recovered after therapy.Conclusion UACE is an effective and less invasive way for CSP,and the complications of TUAE are preventable and curable.