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目的:评价联合氨甲喋呤(MTX)灌注和子宫动脉栓塞术(UAE)治疗剖宫产后子宫疤痕妊娠(CSP)引发大出血的疗效。方法:2010年7月~2013年5月确诊为CSP并发大出血患者52例进行了MTX灌注UAE治疗,超选择插管双侧子宫动脉后注入MTX 50~80 mg,之后采用明胶海绵颗粒栓塞双侧子宫动脉。结果:52例患者UAE成功率100%;无1例严重并发症发生;术后3—7天刮宫术均成功完成,术中出血量平均32.6±10.5 ml。结论:MTX灌注联合UAE是一种安全有效的治疗CSP引发大出血的方法。
OBJECTIVE: To evaluate the efficacy of combined methotrexate (MTX) perfusion and uterine artery embolization (UAE) in the treatment of massive bleeding after cesarean section with uterine scar pregnancy (CSP). Methods: From July 2010 to May 2013, 52 patients with CSP complicated with massive hemorrhage underwent MTX perfusion UAE. The bilateral uterine arteries were cannulated with MTX 50 ~ 80 mg after superselective intubation. Gelatin sponge particles were used to embolize bilateral Uterine artery. Results: The success rate of UAE in 52 patients was 100%. No serious complications occurred. The curettage was successfully performed in 3-7 days after operation. The mean amount of bleeding during operation was 32.6 ± 10.5 ml. Conclusion: MTX perfusion combined with UAE is a safe and effective method to treat CSP-induced hemorrhage.