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目的探讨微创手术治疗异位妊娠在临床应用的可行性。方法对68例异位妊娠患者行右侧股动脉穿刺插管,超选择至患侧子宫动脉,造影观察病变的范围、血供来源及有无活动性出血,然后将甲氨蝶呤150mg稀释至100ml经导管缓慢注入子宫动脉,再用细小的明胶海绵碎粒适量栓塞子宫动脉,至子宫动脉分支不显影为止。结果全组68例异位妊娠均在实施超选择性子宫动脉灌注栓塞术后获得痊愈,其中42例不全流产或输卵管妊娠破裂伴腹腔活动性出血的患者,出血立即得到有效控制,出血停止;15例胚胎存活患者术后第2天超声观查胚胎死亡。68例患者血β-hCG均在术后3～12d降至5U/L以下,腹腔积血1周后全部吸收。1个月后B超复查宫体旁混合性包块完全吸收消失。术后3个月行子宫输卵管造影26例,15例显示患侧输卵管通畅。结论超选择性子宫动脉灌注栓塞治疗异位妊娠,能有效杀灭胚胎组织,栓塞破裂血管,止血效果明显,避免手术创伤,且能保留输卵管。
Objective To investigate the feasibility of minimally invasive surgical treatment of ectopic pregnancy in clinical application. Methods Sixty-eight patients with ectopic pregnancy underwent right femoral artery puncture and intubated to the ipsilateral uterine artery. Angiography was performed to observe the extent of the lesion, blood supply and active bleeding. Methotrexate 150mg was then diluted to 100ml catheter slowly into the uterine artery, and then a small amount of gelatin sponge particles embolization appropriate uterine artery, uterine artery branch is not developed so far. Results All 68 cases of ectopic pregnancy were cured after superselective uterine arterial infusion and embolization. Among them, 42 cases of incomplete abortion or ruptured tubal pregnancy with active peritoneal bleeding were effectively controlled and bleeding stopped immediately. In the case of embryo survival, the embryo was sonicated on the second day after operation. The blood β-hCG in 68 patients decreased to 5U / L 3 ~ 12 days after operation, and was completely absorbed in 1 week after intraperitoneal hemorrhage. 1 month after the B-ultrasound Palace complex mixed completely disappeared. Hysterosalpingography was performed in 26 cases 3 months after operation, and 15 cases showed ipsilateral tubal patency. Conclusion Superselective uterine artery embolization in the treatment of ectopic pregnancy can effectively kill the embryonic tissue, embolization rupture of blood vessels, hemostatic effect is obvious, to avoid surgical trauma, and to retain the fallopian tubes.