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目的:探讨子宫动脉化疗栓塞术(uterine artery chemotherapy embolization,UACE)治疗剖宫产瘢痕部位妊娠(cesarean section scar pregnancy,CSP)的临床疗效。方法:回顾性分析2008年9月~2012年2月安徽省立医院医院收治的17例行子宫动脉灌注化疗加栓塞术治疗子宫瘢痕处妊娠患者的临床资料。结果:17例患者中,7例因瘢痕妊娠贸然清宫术中发生大出血而采用急诊UACE,所有发生大出血患者于UACE术后均停止出血,其中1例在术后第4天妊娠组织自行脱落,复查彩超子宫下段异常回声团消失,彩色多普勒血流信号消失,未予吸宫出院;8例患者采用UACE术后3天在B超监测下行吸宫术,吸宫术中均未出现大出血,自行脱落组织及吸宫组织均送病理,病理可见大量坏死的绒毛组织;4例患者UACE术后配合米非司酮保守治疗3天,其中3例血清人绒毛膜促性腺激素β亚单位(β-HCG)下降明显,疤痕处包块缩小,未清宫出院,1例患者术后血β-HCG下降缓慢,且包块突向子宫浆膜层,UACE术后第7天行子宫疤痕部位局部切除术,术后恢复良好;另4例在吸宫术中已见绒毛组织的患者,UACE术后血β-HCG下降明显,疤痕处包块缩小,未再给予米非司酮及吸宫出院,术后恢复良好。所有患者1月后复查β-HCG均完全降至正常。结论:子宫动脉灌注化疗加栓塞术治疗CSP相对微创、有效,尤其适用于CSP患者大出血的紧急治疗。
Objective: To investigate the clinical efficacy of uterine artery chemotherapy embolization (UACE) in the treatment of cesarean section scar pregnancy (CSP). Methods: The clinical data of 17 cases of uterine scar pregnancy treated by uterine arterial infusion chemotherapy and embolization were retrospectively analyzed from September 2008 to February 2012 in Anhui Provincial Hospital Hospital. Results: Of the 17 patients, 7 cases were treated with emergency UACE due to intraoperative rash of scar pregnancy and all patients with massive bleeding stopped bleeding after UACE. One case died of spontaneous pregnancy on the 4th day after operation, Ultrasonography uterus abnormal echo group disappears, color Doppler blood flow signal disappears, no suction Palace was discharged; 8 patients UACE 3 days after the end of B-monitoring echocardiography, aspiration did not appear in the bleeding, A large number of necrotic villi tissues were found in the pathological and pathological tissues of spontaneous exfoliative tissues and aspiration of the uterus. Four patients were conservatively treated with mifepristone for 3 days after UACE, of which 3 were serum human chorionic gonadotropin subunit β -HCG) decreased significantly, the scars at the block shrinkage, did not clear the palace was discharged, 1 patient postoperative blood β-HCG decreased slowly, and mass protruding uterine serosa, uterine scar site 7 days after UACE local excision Surgery, postoperative recovery was good; the other 4 cases of villus tissue has been seen in patients with suction uterine, UACE blood β-HCG decreased significantly reduced scars mass, did not give mifepristone and suction Palace discharged, Postoperative recovery is good. All patients after a review of β-HCG were completely reduced to normal. Conclusion: Uterine arterial infusion chemotherapy and embolization of CSP is relatively minimally invasive, effective, especially for emergency treatment of bleeding in CSP patients.