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目的探讨急诊行子宫动脉灌注药物栓塞术治疗剖宫产后切口妊娠的可行性和临床价值。方法 2009年10月-2011年12月,对17例临床证实切口瘢痕妊娠并阴道出血患者,急诊行双侧子宫动脉灌注甲氨蝶呤并超选择栓塞术,术后通过观察人绒毛膜促性腺激素(HCG)水平、阴道出血及术后清宫术来评价疗效。结果 17例患者急诊行子宫动脉灌注栓塞术成功,术后阴道出血均停止或减少,HCG水平均明显下降,3例因孕囊自行排除而未行清宫,14例术后2～4 d行胚胎钳刮术,术中出血量较少。所有患者1周后均治愈出院。结论子宫动脉灌注栓塞术是治疗剖宫产术后切口瘢痕妊娠的一种有效方法,可及时治疗阴道大出血,促进杀胚,并为术后清宫提供安全保障。
Objective To investigate the feasibility and clinical value of emergency uterine arterial infusion embolization for cesarean section incision pregnancy. Methods From October 2009 to December 2011, 17 patients with clinically proven scar pregnancy and vaginal bleeding were clinically treated with methotrexate by bilateral uterine arterial infusion and superselective embolization. After observing human chorionic gonadotropin Hormone (HCG) levels, vaginal bleeding and postoperative curettage to evaluate the efficacy. Results 17 patients underwent uterine arterial infusion and embolization successfully. Vaginal bleeding was stopped or decreased after operation. HCG levels were significantly decreased. Three cases were excluded due to gestational sac without clearance, and 14 cases were embryos from 2 to 4 days after operation Forceps curettage, less bleeding during surgery. All patients were cured and discharged after 1 week. Conclusion Uterine arterial perfusion and embolization is an effective method for the treatment of incisional scar pregnancy after cesarean section. It can treat vaginal bleeding in a timely manner, promote the killing of embryo, and provide security for the postoperative curettage.