子宫动脉栓塞术联合宫腔镜在剖宫产术后子宫瘢痕妊娠中的应用.docx

子宫动脉栓塞术联合宫腔镜在剖宫产术后子宫瘢痕妊娠中的应用【摘要】目的探讨子宫动脉化疗灌注栓塞术联合宫腔镜治疗剖宫产术后子宫瘢痕妊娠的临床疗效。方法对18例剖宫产术后子宫瘢痕妊娠患者行双侧子宫动脉选择插管灌注甲氨蝶呤后应用明胶海绵颗粒栓塞术后1周内10例患者行宫腔镜妊娠组织清除术5例患者行B超监视下清宫术3例患者行甲氨蝶呤肌注治疗。结果18例患者均一次成功施行子宫动脉栓塞术术后1周内顺利行宫腔镜手术或清宫术术中出血量少术后1~3个月均恢复正常月经2例患者正常宫内妊娠。结论子宫动脉栓塞术对剖宫产术后子宫瘢痕妊娠止血疗效确切为宫腔镜治疗提供安全保障二者联合应用是一种新型、安全有效、微创的保守治疗方法值得推广应用。【关键词】子宫动脉栓塞术；子宫瘢痕妊娠；宫腔镜TheeffectofuterinearteryembolizationfollowinghysteroscopyinthetreatmentofcesareanscarpregnancyLIJuan.TheFirstPeoplesHospitalofJiningJining272011China【Abstract】ObjectiveToevalulatetheclinicaleffectofuterinearteryembolization(UAE)followinghysteroscopyinthetreatmentofcesareanscarpregnancy(CSP).MethodsUAEwaspreformedbyseldingertechniqueandmethotrexate(MTX)arterychemotherapywasadministedto18caseswithCSPwithinoneweekofUAE10caseshadtheirpregnancyproductsremovedbyhysteroscopy;5casesunderwentdilationandcurettage(D&C)withtheguidanceofultrasonograpy;3casesreceivedanotherdoseofMTXintramuscleinjection.ResultsUAEwassuccessfullycompletedinall18cases.ThefollowingproceduresincludinghysteroscopyandD&CwithinoneweekafterUAEweresafelywithlittlebleeding.Themenstruationrecovered1~3monthafterUAE2patientshadnormalintrauterine.ConclusionUAEmaystopbleedingofCSPwithdefiniteeffectwhichmaymakefurterconservativetreatmentincludinghysteroscopyandD&Cpossible.UAEcombinedwithhysteroscopywasanewsafeeffectivepromisingandminimallyinvasivetherapy.【Keywords】Uterinearteryembolization;Cesareanscarpregnancy;Hysteroscopy剖宫产术后子宫瘢痕妊娠（CesareanscarpregnancyCSP)是指受精卵着床、生长于前次剖宫产切口瘢痕处是剖宫产远期并发症之一也是一种少见而危险的异位妊娠。近年来随着剖宫产率的显著上升其发生率呈上升趋势严重威胁患者的生命安全但CSP的治疗仍是目前临床上非常棘手的问题。随着数字减影血管造影术（DigitalsubstractionangiographyDSA）在临床的广泛应用子宫动脉化疗灌注栓塞术也越来越多地应用于CSP的治疗中［1~3］。为探讨子宫动脉化疗灌注栓塞术联合宫腔镜治疗CSP的临床疗效笔者所在医院对2007年1月~2010年12月间确诊为CSP的18例患者进行了双侧子宫动脉药物灌注栓塞术术后1周内10例行宫腔镜妊娠组织清除术5例行B超监视下清宫术3例行甲氨蝶呤（MethotrexateM