子宫动脉栓塞术联合甲氨蝶呤后清宫治疗剖宫产瘢痕部位妊娠临床分析.doc

子宫动脉栓塞术联合甲氨蝶呤后清宫治疗剖宫产瘢痕部位妊娠临床分析 　　【摘要】 目的：总结子宫动脉栓塞术（UAE）+甲氨蝶呤（MTX）灌注后清宫法治疗剖宫产瘢痕部位妊娠（CSP）的临床效果。方法：回顾性总结24例CSP患者的治疗经过及预后。结果：24例患者中23例在UAE+MTX灌注48 h后在B超引导下行清宫术。22例治疗顺利，术中出血30～80 ml。1例UAE后清宫术中出血不止，经宫腔内放置Foley’s导尿管局部压迫24 h后阴道出血停止。术后监测血β-hCG下降理想。另1例患者术前误诊稽留流产行清宫术中阴道出血不止，经彩超检查明确CSP后急诊行双侧子宫动脉栓塞+MTX灌注，栓塞后阴道出血停止，术后血β-hCG下降，4 d后又呈上升趋势，予MTX序贯给药方案1疗程后监测血β-hCG下降理想。24例患者均治愈，保全了子宫，术后2～6个月包块消失，月经恢复正常。结论：UAE后清宫术是目前治疗CSP首选的保全子宫的行之有效的方法。 　　【关键词】 剖宫产瘢痕部位妊娠； 子宫动脉栓塞； 治疗 　　中图分类号 R714.22 文献标识码 B 文章编号 1674-6805（2015）27-0018-02 　　【Abstract】 Objective：To summary the clinical effect of curettage after uterine artery embolism（UAE） combined with Methotrexate priming in the treatment of cesarean scar pregnancy（CSP）.Method：To retrospectively summarize the therapy and prognosis of 24 cases of caesarean scar pregnancy.Result：23 cases of the patients were treated with UAE and priming，and underwent curettage in 48 hours.22 patients were successfully healing.1 patient presented incessantly vaginal bleeding during curettage.We put a Foley’s Balloon Catheter in uterine cavity for 24 hours and stopped bleeding finally.Another 1 patient was misdiagnosed as missed abortion and presented incessantly vaginal bleeding during curettage，then was confirmed the diagnosis of cesarean scar pregnancy By ultrasound.Vaginal bleeding stopped after emergent uterine artery embolism（UAE） combined with Methotrexate priming.The serum β-hCG ascended after a short time of descent，we adopted Methotrexate sequential antibiotic therapy，the serum β-hCG level declined.All 24 patients were cured and saved from the damage of uterus.Conclusion：Curettage after uterine artery embolism（UAE） combined with Methotrexate priming in the treatment of CSP is effective，safe and reliable clinical therapy with uterine preservation. 　　【Key words】 Cesarean scar pregnancy； Uterine arterial embolism； Therapy 　　First-author’s address：Haidian Hospital of Beijing City，Beijing 100080，China 　　doi：10.14033/j.cnki.cfmr.2015.27.008 　　剖宫产瘢痕部位妊娠（caesare