论文部分内容阅读
目的 :研究经动脉途径化疗及血管栓塞治疗输卵管妊娠并腹腔内出血的可行性。方法 :采用Seldinger技术 ,对 2 5例输卵管妊娠并腹腔内出血患者 ,进行超选择性子宫动脉插管 ,经导管向子宫动脉内灌注甲氨喋呤 (MTX)后行动脉栓塞 ,制止内出血。术后监测血 β HCG水平变化 ,B超监测盆腔包块变化 ,综合评价疗效。 结果 :输卵管妊娠在血管造影下大致显示Ⅰ、Ⅱ型 2种血管征象。Ⅰ型为宫旁可见片状异常血管染色 ,Ⅱ型为宫旁圆形异常血管染色。 2 5例中 ,Ⅰ型表现者 4例 ,Ⅱ型表现者 2 1例。 2 4例达治愈标准 ,治愈率 96%。血 β HCG降至正常平均需时 14 .4± 11.5天 ,月经恢复正常平均需时 2 9.78± 7.1天 ,10例要求生育者 ,进行子宫输卵管造影 (HSG) ,9例显示通畅 ,1例不全梗阻。结论 :经动脉途径灌注杀胚药物及血管栓塞 ,不仅提高杀胚药物的疗效 ,而且能有效的制止和预防内出血 ,扩大了保守治疗的适应症。
Objective: To study the feasibility of transcatheter arterial chemotherapy and embolization for tubal pregnancy and intraperitoneal hemorrhage. Methods: Twenty-five patients with tubal pregnancy and intraperitoneal hemorrhage were treated with Superselective uterine arterial catheterization by Seldinger technique. Thromboxane was injected intraarterially into the uterine artery for arterial embolization to prevent internal bleeding. Postoperative blood levels of β-HCG monitoring, B-ultrasound monitoring of pelvic mass changes, a comprehensive evaluation of the curative effect. Results: Tubal pregnancy in angiography generally shows Ⅰ, Ⅱ type 2 vascular signs. Type I for the paravertebral visible flaky vascular staining, type II for the uterine circular abnormal vascular staining. Among 25 cases, 4 cases showed type I and 21 cases showed type II. 24 cases of up to the standard cure rate of 96%. The mean serum HCG decreased to 14.4 ± 11.5 days on average, and the mean time to normal menstruation returned to 2 9.78 ± 7.1 days. Ten cases requiring fertility were undergone HSG. Nine cases showed patency and one case was incomplete obstruction. CONCLUSION: Percutaneous intra-arterial infusion of drugs and blood vessel embolization not only improves the curative effect of the drug for killing embryo, but also stops and prevents internal bleeding effectively and expands the indications of conservative treatment.