介入治疗子宫瘢痕妊娠及异位妊娠大出血临床观察(1)
【摘要】 目的 探讨介入治疗子宫瘢痕妊娠及异位妊娠大出血的方法和疗效。方法 29例子宫瘢痕妊娠和16例异位妊娠大出血患者， 急诊下采用改良seldinger法用猪尾导管和子宫动脉导管造影， 明确是否双侧子宫动脉出血， 造影证实后分别经导管行双侧子宫动脉内灌注甲氨蝶呤(MTX)和明胶海绵颗粒或聚乙烯醇颗粒(PVA)栓塞剂， 观察治疗效果。结果 本组45例患者均成功施行双侧子宫动脉灌注化疗栓塞术， 无一例并发症发生， 术后患者阴道不规则流血即刻停止， 2～3 d行胚胎钳刮清宫术， 术中刮出物病理报告为坏死的绒毛组织， 术中仅有少量出血， 出血量<60 ml， 平均出血量30 ml， 复查血β-人绒毛膜促性腺激素(β-HCG)均在术后6～15 d恢复正常， 所有患者月经正常。随访3～9个月无再次出血。结论 急诊双侧子宫动脉灌注化疗栓塞术治疗子宫瘢痕妊娠及异位妊娠大出血是安全、可行的方法， 应大力推广。
【关键词】 子宫瘢痕妊娠；子宫动脉栓塞；异位妊娠；大出血；明胶海绵
DOI：10.14163/j.cnki.11-5547/r.2017.25.014
【Abstract】 Objective To explore the method and efficacy of interventional treatment in uterine scar pregnancy and ectopic pregnancy hemorrhage. Methods A total of 29 patients with uterine scar pregnancy hemorrhage and 16 patients with ectopic pregnancy hemorrhage， and they received pigtail catheter and uterine artery catheter angiography by modified seldinger method， so as to clear whether the bilateral uterine artery bleeding or not. After transcatheter angiography， bilateral methotrexate (MTX) and gelfoam granules or polyvinyl alcohol (PVA) granules were infused into the bilateral uterine arteries. The treatment effect was observed. Results All the 45 patients underwent bilateral uterine artery infusion chemotherapy embolization without complications case. Irregular vaginal bleeding stopped immediately after operation， and 2～3 d after， embryo forceps curettage was performed， with intraoperative scrapings pathological report as necrotic villus tissue. There was only a small amount of intraoperative bleeding， with bleeding volume less than 60 ml， and the average blood loss was 30 ml.The expression of β-human chorionic gonadotropin (β-HCG) was normal in 6 ～ 15 days after operation， all patients had normal menstruation. The patients were followed up for 3～9 months without rebleeding. Conclusion Emergency bilateral uterine artery infusion chemotherapy embolization is a safe and feasible method for the treatment of uterine scar pregnancy and ectopic pregnancy hemorrhage， and it should be popularized.
【Key words】 Uterine scar pregnancy； Uterine artery embolization； Ectopic pregnancy； Hemorrhage； Gelatin sponge
近年來随着全球剖宫产率上升， 早期检验水平的提高及经阴道超声的广泛应用， 剖宫产后子宫瘢痕妊娠及异位妊娠大出血的发病率逐年升高[1， 2]。随着介入治疗技术的成熟应用， 使子宫瘢痕妊娠及异位妊娠大出血治疗取得了较好的疗效。现将本院2006年9月～2016年9月急诊收治的29例子宫瘢痕妊娠和16例异位妊娠大出血患者资料进行分析， 探讨介入治疗子宫瘢痕妊娠及异位妊娠大出血的方法和疗效。
1 资料与方法
1. 1 一般资料 本院2006年9月～2016年9月急诊收治的子宫瘢痕妊娠大出血患者29例， 年龄22～45岁， 平均年龄34岁；异位妊娠大出血患者16例， 年龄21～46岁， 平均年龄33岁。患者均多次受孕， 阴道不规则流血史4～36 d， 出血量1000～2500 ml， 平均出血量(1300±2100)ml， 血β-HCG水平270～34120 U/L， 平均血β-HCG水平2100 U/L， 均有不同程度腹痛史， 在大出血时出现子宫下段积血， 可致宫颈阴道段缩短， 前穹窿及子宫下段膨出， 宫体硬而下段软， 宫体与子宫下段等宽， 出血时间4～24 h， 经输血、输液、止血、填塞纱条等保守治疗无效。, 百拇医药(张帆 许哲)
【关键词】 子宫瘢痕妊娠；子宫动脉栓塞；异位妊娠；大出血；明胶海绵
DOI：10.14163/j.cnki.11-5547/r.2017.25.014
【Abstract】 Objective To explore the method and efficacy of interventional treatment in uterine scar pregnancy and ectopic pregnancy hemorrhage. Methods A total of 29 patients with uterine scar pregnancy hemorrhage and 16 patients with ectopic pregnancy hemorrhage， and they received pigtail catheter and uterine artery catheter angiography by modified seldinger method， so as to clear whether the bilateral uterine artery bleeding or not. After transcatheter angiography， bilateral methotrexate (MTX) and gelfoam granules or polyvinyl alcohol (PVA) granules were infused into the bilateral uterine arteries. The treatment effect was observed. Results All the 45 patients underwent bilateral uterine artery infusion chemotherapy embolization without complications case. Irregular vaginal bleeding stopped immediately after operation， and 2～3 d after， embryo forceps curettage was performed， with intraoperative scrapings pathological report as necrotic villus tissue. There was only a small amount of intraoperative bleeding， with bleeding volume less than 60 ml， and the average blood loss was 30 ml.The expression of β-human chorionic gonadotropin (β-HCG) was normal in 6 ～ 15 days after operation， all patients had normal menstruation. The patients were followed up for 3～9 months without rebleeding. Conclusion Emergency bilateral uterine artery infusion chemotherapy embolization is a safe and feasible method for the treatment of uterine scar pregnancy and ectopic pregnancy hemorrhage， and it should be popularized.
【Key words】 Uterine scar pregnancy； Uterine artery embolization； Ectopic pregnancy； Hemorrhage； Gelatin sponge
近年來随着全球剖宫产率上升， 早期检验水平的提高及经阴道超声的广泛应用， 剖宫产后子宫瘢痕妊娠及异位妊娠大出血的发病率逐年升高[1， 2]。随着介入治疗技术的成熟应用， 使子宫瘢痕妊娠及异位妊娠大出血治疗取得了较好的疗效。现将本院2006年9月～2016年9月急诊收治的29例子宫瘢痕妊娠和16例异位妊娠大出血患者资料进行分析， 探讨介入治疗子宫瘢痕妊娠及异位妊娠大出血的方法和疗效。
1 资料与方法
1. 1 一般资料 本院2006年9月～2016年9月急诊收治的子宫瘢痕妊娠大出血患者29例， 年龄22～45岁， 平均年龄34岁；异位妊娠大出血患者16例， 年龄21～46岁， 平均年龄33岁。患者均多次受孕， 阴道不规则流血史4～36 d， 出血量1000～2500 ml， 平均出血量(1300±2100)ml， 血β-HCG水平270～34120 U/L， 平均血β-HCG水平2100 U/L， 均有不同程度腹痛史， 在大出血时出现子宫下段积血， 可致宫颈阴道段缩短， 前穹窿及子宫下段膨出， 宫体硬而下段软， 宫体与子宫下段等宽， 出血时间4～24 h， 经输血、输液、止血、填塞纱条等保守治疗无效。, 百拇医药(张帆 许哲)