子宫动脉栓塞术在剖宫产术后子宫瘢痕妊娠治疗中的应用

摘要

目的 探讨子宫动脉栓塞术(UAE)在剖宫产术后子宫瘢痕妊娠(CSP)治疗中的应用价值.方法 2007年1月至2011年6月共收治CSP患者35例,根据是否行UAE分为栓塞组(21例)和非栓塞组(14例).栓塞组中,16例在UAE 后24 ～ 48 h行清宫术,5例在UAE后行开腹或阴式病灶切除术.非栓塞组中8例直接行清宫术,3例病灶局部注射甲氨蝶呤后行清宫术,3例直接开腹行病灶切除术.比较两组患者术中出血量、住院时间、β-人绒毛膜促性腺激素(β-HCG)值降至正常时间的差异.结果 栓塞组21例患者UAE操作成功,全部患者保留子宫,平均住院时间为(11.5 ± 3.6 )d,β-HCG值降至正常的平均时间为(18.6 ± 4.9)d,而非栓塞组则分别为(20.4 ± 5.2) d和(28.7 ± 5.6)d.非栓塞组中2例由于术中出血汹涌,被迫行子宫切除术.结论 UAE术是一种有效的治疗CSP的方法,创伤小、成功率高,保留了患者的生育功能,能起到明显的防止出血和止血的作用.%Objective To assess the clinical value of uterine arterial embolization (UAE) in treating uterine scar pregnancy after cesarean section. Methods A total of 35 cases with cesarean scar pregnancy , admitted to authors' hospital during the period from Jan. 2007 to June 2011, were divided into two groups: embolization group (n = 21) and non-embolization group (n = 14). By using Seldinger technique, UAE was performed via the right femoral access and gelatin sponge particle was used as embolization agent to occlude the uterine artery. In embolization group, sixteen patients received uterine cavity curettage one or two days after UAE, while five patients received laparotomy or perineotomy surgery to remove the lesions after UAE. In non-embolization group, uterine cavity curettage was performed directly in 8 patients , local injection of methotrexate followed by uterine cavity curettage was carried out in 3 patients, and direct laparotomy to remove the lesions was adopted in the remaining 3 patients. The blood loss during the procedure, the hospitalization days and the time for |3-HCG levels falling to normal were documented. The results were compared between the two groups. Results UAE was successfully accomplished in all the 21 patients of embolization group and the uterus was preserved in all patients. For the embolization group , the mean hospitalization time was(11.5 ± 3.6)days, and the time for |3-HCG levels falling to normal was (18.6 ± 4.9) days. For the non-embolization group, the mean hospitalization time was(20.4 ± 5.2)days, and the time for P-HCG levels falling to normal was (28.7 ± 5.6)days. Hysterectomy had to be carried out in two patients of non-embolization group due to the massive bleeding occurred in therapeutic procedures. Conclusion For the treatment of cesarean scar pregnancy , UAE is very effective and mini-invasive with high success rate. UAE can preserve the patient's reproductive function , and it also plays a significant role in preventing hemorrhage and assisting hemostasis. (J Intervent Radiol, 2012, 21: 410-413)