Objective To evaluate percutaneous uterine artery methotrexate infusion and embolization in the treatment of postpartum hemorrhage from the uterine scar after cesarean section.Methods From January 2010 through November 2012,9 patients with postpartum hemorrhage from uterine scar after cesarean section underwent bilateral superselective uterine artery chemoembolization with infusion of methotrexate and gelfoam.Hysteroscopic uterine curettage was performed within 3 to 7 days to monitor any bleeding and treatment response.Results The procedure was successful in all patients with 10-40 ml of intrauterine bleeding.Embryonic villi and fibrous tissues were found in the curettage specimens.The serum β-HCG returned to normal at 14 to 43 days after the procedure.The average duration of hospitalization was 9.2±2.4 days.The myometrium and endometrial cavity appeared normal on follow-up Doppler ultrasound.There were no complications including uterine rupture,endometritis,or adhesions.Conclusions Uterine artery methotrexate infusion and embolization followed by hysteroscopic curettage is a safe and effective treatment for postpartum hemorrhage from caesarian section-induced uterine scar with less bleeding,fewer complications and shorter hospitalization time compared to hysterectomy.%目的：探讨经子宫动脉MTX灌注+栓塞联合宫腔镜下清宫术治疗子宫疤痕妊娠的临床应用价值。方法自2010年1月～2012年11月，我院剖宫产后子宫疤痕妊娠患者9例，行双侧子宫动脉超选择性插管，缓慢灌注氨甲喋呤（MTX）后用明胶海绵颗粒（直径710～2100 um）及条栓塞双侧子宫动脉，3～7 d内在宫腔镜下行清宫术，观察术中出血量及术后疗效。结果9例患者均成功施行了子宫动脉MTX灌注+栓塞联合宫腔镜下清宫术，术中出血量约10～40 ml，术后复查血β-HCG，14～43 d降至正常，住院时间平均（9.2±2.4）d，无子宫穿孔、宫腔感染及粘连等并发症。结论子宫动脉MTX灌注+栓塞联合宫腔镜下清宫术治疗子宫疤痕妊娠，可有效控制出血量、并发症少、住院时间短，是一种安全、有效的治疗方法。
展开▼
