目的：探讨两种特殊部位妊娠终止妊娠时应用经导管子宫动脉药物灌注及栓塞术+宫腔镜下刮宫术的治疗价值。方法：回顾性分析2010年6月-2012年11月在本院收治的40例特殊部位妊娠患者，其中剖宫产术后子宫瘢痕妊娠（CSP）患者33例，宫颈妊娠（CP）患者7例。所有患者术前均经超声检查明确诊断，采用经导管双侧子宫动脉内灌注甲氨蝶呤每侧各25 mg，然后予以明胶海绵颗粒栓塞双侧子宫动脉。结果：子宫动脉插管成功率100%，所有病例第2~7天行宫腔镜检查+刮宫术，术中出血量30~80 mL，平均60 mL，刮宫组织均送病理活检，病理可见大量坏死的绒毛组织。出院后1~3个月随访，B超示子宫正常大小，均未见异常回声及异常血流信号。结论：利用经导管子宫动脉药物灌注及栓塞术+宫腔镜下刮宫术具有降低大出血风险、保留妇女生育功能的优点，既安全有效，又无严重并发症发生，复发率低，治疗时间短，无不良预后现象，可作为CSP及CP的首选治疗方法。%Objective:To evaluate the therapeutic value of transcatheter uterine artery chem-embolization(UACE)+curettage under hysteroscopy in a cesarean scar pregnancy(CSP)or a cervix pregnancy(CP)in the termination of pregnancy.Method:40 pregnancies with special parts from June 2010 to December 2012 in our hospital were analyzed retrospectively,the cesarean scar pregnancy(CSP)in 33 cases,and cervical pregnancy in 7 cases.All patients were diagnosised by ultrasonic inspection.Methotrexate was infused by transcatheter bilateral uterine artery,each side had 25 mg, then by using gelatin sponge particles to bilateral uterine artery embolization.Result:The successful rate of catheterization was 100%.40 cases treated with UACE had bleeding 30-80 mL(an average of 60 mL)during curettage under hysteroscopy within 2-7 days.The necrotic villus was found in the tissue from curettage by pathologic examination.After discharge 1 to 3 months follow-up,b-ultrasonography showed normal size uterus,no abnormal echo signal and blood signal was not found by color Doppler.Conclusion:Uterine artery chem-embolization(UACE)+curettage under hysteroscopy has the advantages of remaining women reproductive function and lowing bleeding risk.It is safe,effective,and no serious complications, low recurrence rate,short treatment period,no adverse prognostic phenomenon,can be used as the preferred method of treatment of CSP and CP.
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