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.
摘要:目的: 探讨经子宫动脉介入化疗栓塞治疗剖宫产切口瘢痕妊娠的应用价值。 方法 :回顾分析本院自2006年7月至2007年12月子宫动脉介入治疗的15例剖宫产切口瘢痕妊娠病例资料。 结果 :15例介入治疗均成功,其中8例化疗及明胶海绵栓塞后加用弹簧圈栓塞,术后阴道流血停止,孕囊明显缩小,血清人绒毛膜促性腺激素明显下降。术后清宫无大出血,病理检查示子宫瘢痕部位绒毛、蜕膜或胎盘组织,有变性、坏死。 结论 :经子宫动脉介入治疗剖宫产瘢痕妊娠,能有效预防和控制出血,减小清宫危险,并保留子宫,是剖宫产瘢痕妊娠安全、有效的治疗方法之一。 Abstract: Objective: To investigate the value of uterine artery chemotherapy and embolization in the treatment of cesarean scar pregnancy. Methods : Fifteen cases with cesarean scar pregnancy performed with uterine artery interventional therapy were retrospectively analyzed from July, 2006 to December, 2007 in our hospital. Results : All cases were treated successfully by uterine artery chemotherapy and embolism. All cases were embolized with gelatin sponge after chemotherapy, and eight with spring ring additionally. Vaginal bleedings were stopped after uterine artery embolization. Gestation sacculi deflated obviously. Serum human chorionic gonadotrophin descended dramatically. There was no severe vaginal bleeding by curettage after interventional therapy. The villi, decidua, or placental tissues were observed with degeneration and necrosis by pathology. Conclusion : Uterine artery chemotherapy and embolization was proved to be a safe and useful procedure for preventing and controlling vaginal bleeding, diminishing the risk of curettage and avoiding the loss of uterus.
ObjectiveTo compare the curative effect of three therapeutic strategies for cesarean scar pregnancy (CSP). MethodsBetween January 2009 and December 2013, 208 patients with CSP underwent intramuscular methotrexate alone (group A, n=72), transvaginal ultrasound monitoring after embryo sac strangulation after injection of methotrexate (group B, n=70) and uterine arterial chemoembolization therapy monitoring after hysteroscopy surgery (group C, n=66). We studied their clinical data retrospectively. The preoperative treatment interval, the hospitalization days, intraoperative bleeding, time of blood β-HCG to normal level and hospitalization costs were compared between the groups. ResultsThe preoperative treatment interval, hospitalization days, intraoperative bleeding, and time of blood β-HCG to normal level of group C were significantly better than those of group A and B (P<0.05), while the hospitalization cost of the three groups were not statistically signficant (P>0.05). ConclusionAs a treatment for CSP, uterine artery chemoembolization is a safe and effective method, and it has the advantages of short hospitalization time, less intraoperative bleeding and high fertility preservation. It is worth application in clinical medicine.
ObjectiveTo compare the clinical efficacy of methotrexate perfusion combined with interventional treatment and the traditional treatment with methotrexate and mifepristone for cesarean scar pregnancy. MethodA total of 589 patients diagnosed with cesarean scar pregnancy after surgery between January 2012 and March 2015 in our hospital were selected to be our study subjects. The patients were informed of the two kinds of treatment, and based on their own will, they were arranged into corresponding groups. Group A had 234 patients who were willing to undergo the conventional therapy:intramuscular injection of methotrexate (20 mg, once per day for 5 days); oral mifepristone (50 mg once per day for 3 to 5 days); and the continuation of drugs was determined by local pregnancy tissue blood flow on B ultrasound and liver function of the patients. Group B had 255 patients who selected uterine artery perfusion and arterial embolism. There was no significant difference in terms of age, serum human chorionic gonadotrophin (HCG) and uterine incision gestation sac size between the two groups of patients (P>0.05). Then we compared the treatment effect between the two groups. ResultsThe differences in the amount of bleeding, the time of blood HCG dropped to normal, and hospitalization duration between the two groups were significant (P<0.05), while in the rate of hysterectomy, drug-induced liver injury were not (P<0.05). ConclusionsMethotrexate perfusion combined with interventional treatment is better than the traditional treatment with methotrexate and mifepristone for cesarean scar pregnancy in terms of clinical efficacy and safety.
Objective To investigate the clinical effect of high intensity focused ultrasound (HIFU) and uterine artery embolization (UAE) in the treatment of cesarean scar pregnancy (CSP). Methods A total of 152 patients with CSP diagnosed by B-type ultrasonography were enrolled prospectively in this study from June 2014 to May 2016 in Chengdu Women and Children’s Central Hospital and Suining Central Hospital. Six patients from Chengdu Women and Children’s Central Hospital and 84 from Suining Central Hospital for Volunteered HIFU treatment were regarded as observation group. The other 62 patients from Chengdu Women and Children’s Central Hospital were selected to accept UAE treatment voluntarily were designated as control group. The clinical efficacy and therapeutic safety of the two groups were compared after the treatment. Results Eighty-two patients (91.1%) in the observation group and 32 (51.6%) in the control group had a bleeding volume equal to 100 mL or lower during complete curettage of uterine cavity (P<0.05). The hospitalization expenses of the above two groups were respectively (25 126.51±1 473.49) and (32 928.42 ±1 579.35) yuan (P<0.05). The hospitalization time was (11.03±1.52) and (10.65±1.87) days respectively, and the difference was not statistically significant (P>0.05). There was no significant difference in the normal rate of human chorionic gonadotropin recovery between the observation group and the control group at 14 days after treatment (P>0.05). Eighty-seven patients (96.7%) in the observation group and 51 (82.3%) in the control group had their menstrual recovery to normal level at 2 months after treatment, and the difference was statistically significant (P<0.05). The incidence of postoperative complications was 1.1% and 6.4% in the observation group and the control group, respectively, and the difference was not statistically significant (P>0.05). Conclusions HIFU in the treatment of CSP is safe and effective. Compared with UAE, HIFU requires less cost with fewer complications, which is worth promoting.
ObjectivesTo systematically review the safety and effectiveness of uterine artery embolization (UAE), surgery and high intensity focused ultrasound (HIFU) in the treatment of uterine fibroids.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases were electronically searched to collect relevant studies on comparing the safety and effectiveness of UAE, surgery and HIFU in the treatment of uterine fibroids from January 2000 to August 2019. Two reviewers independently screened the literature, extracted the data and evaluated the risk of bias of included studies, network meta-analysis was performed by ADDIS 1.16.8 software and Stata 14.0 software.ResultsA total of 11 trials (22 references) involving 3469 patients were included. Compared with surgery, UAE and HIFU patients had higher quality of life (1-year follow-up) improvement, and UAE was higher than HIFU. Network meta-analysis showed that patients treated with HIFU had the lowest incidence of major complications within 1 year, followed by UAE, and surgery. Patients treated with HIFU and UAE had shorter hospitalization and quicker recovery time than surgery. The rate of further intervention after surgery treatment might be lower than that of UAE and HIFU.ConclusionsUAE has the highest quality of life improvement (1-year follow-up) for uterine fibroids. HIFU and UAE are safer with shorter hospital stays and quicker recovery time compared with surgery. However, both UAE and HIFU have the risk of re-treatment. However, limited by the number and quality of included studies, the above conclusions are needed to be verified by more high-quality studies.