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。
目的 探讨子宫动脉化疗栓塞在剖宫产术后子宫切口妊娠治疗中的可行性和安全性。 方法 回顾分析2006年7月－2011年3月收治的152例剖宫产切口瘢痕妊娠行介入治疗的病例资料。 结果 152例子宫动脉化疗栓塞操作均成功。阴道大出血或不规则出血均得到有效控制。人绒毛膜促性腺激素β亚型较术前下降，差异有统计学意义（Z=−9.295，P=0.000），术后2～22 d行清宫术，术中失血3～100 mL，平均27 mL。3例行子宫切除术，子宫切除率2%。1例发生栓子脱落导致左下肢胫前动脉栓塞并发症。 结论 子宫动脉化疗栓塞治疗剖宫产术后切口妊娠可有效控制大出血、降低清宫风险、降低子宫切除风险，是治疗切口妊娠的有效可行方法之一。
【摘要】 目的 探讨子宫部位异位妊娠的临床特征和处理对策。 方法 回顾分析2002年9月-2009年9月间收治的31例子宫部位异位妊娠患者的临床资料。 结果 31例患者中，初诊确诊仅8例，误诊率74.2%。除5例因难以控制的大出血行经腹病灶清除术加子宫修补术或全子宫切除术外，其余26例患者均经氨甲喋呤（MTX）治疗加清宫术或宫腔镜下病灶清除术保守治疗成功。 结论 子宫部位异位妊娠容易误诊，超声检查是诊断的主要方法。保守治疗安全、有效，可保留生育能力。氨甲喋呤治疗加清宫术可作为治疗子宫部位异位妊娠的主要方法。【Abstract】 Objective To investigate the clinical characteristics and treatment of ectopic pregnancy in the uterus. Methods The clinical data of 31 patients diagnosed as ectopic pregnancy from September 2002 to September 2009 were analyzed retrospectively. Results During preliminary diagnosis, only eight patients were accurately diagnosed.The error rate of first diagnosis was 74.2%. Five patients suffered focal cleaning and uterus neoplasty or total hysterectomy due to uncontrollable bleeding.The other 26 patients were successfully cured by conservation treatment of methotrexate (MTX) combined with dilatation and curettage or clearance of focal lesion under hysteroscopy. Conclusion Misdiagnosis of ectopic pregnancy in the uterus is easy to make.The ultrasonography is the main method for the diagnosis of ectopic pregnancy in the uterus.Conservative treatment is proved to be safe and effective and can preserve the patients’ fertility. Administration of MTX combined with dilatation and curettage is an main therapeutic method in handling ectopic pregnancy in the uterus.
【摘要】 目的 探讨双侧子宫动脉化疗栓塞术治疗剖宫产子宫切口妊娠的临床应用价值。 方法 2004年3月-2009年10月确诊剖宫产子宫切口妊娠的患者25例。首先行双侧子宫动脉超选择插管，注入甲氨喋岭，再用明胶海绵条栓塞双侧子宫动脉，48~72 h内在B型超声监测下行清宫术。 结果 25例子宫动脉化疗栓塞术后复查B型超声，提示孕囊血供明显减少。22例在B型超声监测下一次性清除胚胎组织，出血量少；2例因胚胎植入肌层突向浆膜层栓塞术后加用氟尿嘧啶，未行清宫，自行排出；1例因术后切口处形成大血肿行手术治疗。 结论 双侧子宫动脉化疗栓塞术是治疗剖宫产子宫切口妊娠一种有效方法，既保留子宫，又保留其生育功能。【Abstract】 Objective To evaluate the application of bilateral uterine artery chemoembolization for caesarean scar pregnancy (CSP）. Methods A total of 25 patients with CSP From March 2004 to October 2009 were selected. Bilateral uterine artery super selective catheterization was performed after injection with methotrexate, and gelatin sponge granules were injected into blateral uterine artery. Then atificial abortion was performed under B-ultrasonic scanning within 48-72 hours. Results In all 25 cases, the blood flow of the embryo decreased significantly after uterine artery chemoembolization. A total of 22 patients received artificial abortion successfully with little vaginal bleeding;two pateints received medication with 5-FU duet to the embryo near to the perimetrium, and finally the embryo expulsed spontaneously;one patient underwent hysterectomy, because a huge hematoma was formed at the incision of the uterus after uterine artery chemoembolization. Conclusion Bilateral uterine artery chemoembolization is effective for CSP, which could keep the uterus and the patients’ reproductive function.
ObjectiveTo explore the nursing method for patients with urerine incision pregnancy. MethodsBetween July 2012 and April 2013, 82 patients with uterine incision pregnancy were selected, including 6 with massive haemorrhage after dilatation and evacuation in other hospitals before received in our department. All of the patients underwent arterial chemotherapy infusion and embolization; dilatation and evacuation was performed under the monitoring of B-scan ultrasound; and the patients received intensive care. ResultsAll of the 82 patients with uterine incision pregnancy were cured via proper treatment and care. ConclusionUterine artery embolization is an effective treatment method for pregnancy incision, which has advantages like minimally invasion, quick effect, and uterus preservation. Strengthen psychological care and close observation of the disease, as well as health guidance are important for the success of incision pregnancy treatment.
ObjectiveTo investigate the value of uterine compression suture through laparoscopy in the treatment of cesarean scar pregnancy (CSP). MethodsA random controlled study was conducted on 85 CSP patients diagnosed between September 2013 and December 2014. The patients were randomly divided into control group (n=43) and study group (n=42). The control group received routine evacuation under laparoscopy, while the study group received routine evaluation under laparoscopy combined with uterine compression suture. The efficacy of the two treatments were compared and analyzed. ResultsThe operation time of the control group and the study group was (36.6±17.7) and (45.6±14.8) minutes, respectively. Total amount of bleeding during and after the operation was (207.9±165.8) and (96.1±29.0) mL for the two groups of patients, and the above differences were statistically significant (P＜0.05). There was no significant difference in the indicators of anal exhaust time, hospitalization stay, blood β-human chorionic gonadotrophin clearance time, and menstruation recovery time between the two groups (P>0.05). ConclusionUterine compression suture through laparoscopy is a safe and reliable method to reduce the bleeding of CSP, which is easy to perform and worthy of promotion.