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目的:评价5-氟尿嘧啶(5-Fu)子宫动脉化疗栓塞术联合清宫术在剖宫产术后子宫瘢痕妊娠治疗中的效果。方法:回顾性分析上海市同济大学附属第一妇婴保健院2014年3月至2015年5月计划生育科收治的剖宫产术后子宫瘢痕妊娠27例患者的临床资料。所有患者均行超选择性子宫动脉插管,造影,灌注5-Fu及明胶海绵栓塞,48~96 h后再联合B超监护下行清宫术,清除妊娠组织。观察子宫动脉化疗栓塞术后24 h血β-人绒毛膜促性腺激素(β-HCG)及B超的变化、患者化疗栓塞术后不良反应情况。观察清宫术中出血情况、术后24 h血β-HCG水平及B超情况。结果:27例患者均超选择插管灌注及栓塞成功。栓塞术后24 h血β-HCG下降>50%,复查B超显示胚胎血供明显减少或消失,与栓塞术前比较差异有统计学意义(P<0.05)。所有患者化疗栓塞术后不良反应轻微,对症治疗均能好转。刮宫术中出血量均<20 ml,无一例发生大出血及子宫穿孔情况。刮宫术后24 h血β-HCG下降>50%,术后24 h复查B超24例显示切口处回声不均匀,内膜不平整。3例显示清宫术后切口处残余混合性回声。电话随访所有患者均于2个月内转经。结论:5-Fu子宫动脉化疗栓塞术联合清宫术在剖宫产术后子宫瘢痕妊娠治疗中是一种安全有效的方法,值得推广运用。
OBJECTIVE: To evaluate the efficacy of 5-fluorouracil (5-Fu) combined with uterine artery chemoembolization in the treatment of uterine scar pregnancy after cesarean section. Methods: The clinical data of 27 cases of uterine scar pregnancy after cesarean section were collected from the First Affiliated MCH Hospital of Tongji University from March 2014 to May 2015 were retrospectively analyzed. All patients underwent superselective uterine artery cannulation, angiography, perfusion of 5-Fu and gelatin sponge embolization, 48 ~ 96 h and then combined with B-ultrasonography curettage, removal of pregnancy tissue. The changes of β-HCG and B-ultrasound in 24 h after uterine arterial chemoembolization were observed. The adverse reactions after chemotherapy and embolization were observed. Observe the bleeding during surgery, serum levels of β-HCG and B-ultrasound after 24 h. RESULTS: Twenty-seven patients underwent successful intubation and embolization. Blood β-HCG decreased by 50% at 24 h after embolization. The examination of B-ultrasound showed that the blood supply of embryos decreased or disappeared significantly, which was significantly different from that before embolization (P <0.05). All patients with mild adverse reactions after chemotherapy, symptomatic treatment can be improved. Bleeding in curettage were <20 ml, no case of bleeding and uterine perforation. 24 h after curettage serum β-HCG decreased> 50%, 24 h after the operation of ultrasound B showed 24 cases of echographic incision uneven endometrial irregularities. 3 cases show the remnants of the curettage residual mixed echo. Telephone follow-up All patients were transferred within 2 months. Conclusion: 5-Fu uterine artery chemoembolization combined with curettage in cesarean section after uterine scar pregnancy treatment is a safe and effective method, it is worth promoting the use of.