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目的探讨子宫动脉灌注化疗栓塞术在宫颈妊娠保守治疗中的临床应用价值。方法对8例宫颈妊娠患者行双侧子宫动脉灌注甲氨蝶呤(MTX),再使用明胶海绵颗粒栓塞双侧子宫动脉,观察栓塞术后第2、4、6天血人绒毛膜促性腺激素(β-h CG)下降情况,结合血β-h CG下降比于术后3～5 d在B超引导下行宫颈管搔刮术。结果 8例患者均成功实施子宫动脉灌注化疗栓塞术,术后无严重并发症,阴道出血显著减少或停止,术后第2、4、6天血β-h CG值与术前比较显著下降,其中5例患者术后第2天、3例患者术后第4天血β-h CG下降比>50%,分别于术后第3~5天在B超引导下行宫颈管搔刮术,手术顺利,出血量少,8例患者术后第6天血β-h CG水平下降比均>90%。结论子宫动脉灌注化疗栓塞能够迅速制止宫颈妊娠出血,有效杀灭胚胎,快速降低血β-h CG,减少出血量,结合术后血β-h CG下降比适时在B超引导下行宫颈管搔刮术,降低宫颈管搔刮术时的风险,保全了患者的生育能力,是宫颈妊娠治疗安全、有效、微创的方法。
Objective To investigate the clinical value of uterine arterial chemoembolization in the conservative treatment of cervical pregnancy. Methods Eight patients with cervical pregnancy underwent bilateral uterine artery perfusion of methotrexate (MTX), and then using gelatin sponge particles embolization of bilateral uterine artery, observed after embolization of blood 2,4,8 human chorionic gonadotropin (β-h CG) decline, the combination of blood β-h CG decreased than 3 to 5 days after the B-guided cervical scraping curettage. Results All the 8 patients underwent successful uterine arterial chemoembolization without any serious complication. Vaginal bleeding was significantly reduced or stopped after operation. The blood β-h CG values at 2, 4 and 6 days after operation were significantly lower than those before operation, In 5 of them, the blood β-h CG decreased more than 50% on the 2nd day after operation and in 3 patients on the 4th day after operation. Smooth, less bleeding, 8 patients after 6 days of blood β-h CG levels were decreased by> 90%. Conclusion Uterine arterial chemoembolization can quickly stop cervical pregnancy bleeding, effectively kill embryos, rapidly reduce blood β-h CG, reduce the amount of bleeding, combined with postoperative blood β-h CG decreased than timely under the B-guided cervical canal scraping Surgery to reduce the risk of cervical canal scraping surgery to preserve the patient’s fertility, cervical pregnancy treatment is safe, effective and minimally invasive method.