摘要
目的观察氨甲蝶呤(MTX)子宫动脉化疗栓塞(UACE)联合清宫术治疗瘢痕妊娠(CSP)的有效性和安全性。方法回顾性收集29例经超声和/或MRI确诊CSP、接受UACE及其后72 h内清宫术的CSP患者,评估治疗效果,记录清宫术中出血量、妊娠物量及治疗相关并发症,以及治疗后血β-人绒毛膜促性腺激素(β-HCG)及声像图变化,并随访月经情况。结果对29例均成功实施UACE及清宫术,清宫术中出血量5~50 ml、中位出血量10 ml,妊娠物量10~100 ml、中位妊娠物量20 ml。UACE中1例发生迷走神经反射,予静脉推注1 mg阿托品后好转。UACE后1周内29例均出现栓塞后综合征,予甲泼尼龙治疗后缓解。完成联合治疗后血β-HCG由治疗前的78997.00(23150.50,201975.50)mIU/ml降至2873.00(1873.00,4182.50)mIU/ml(Z=-6.322,P=0.001);血β-HCG于治疗后15~27天、平均(20.2±3.3)天恢复正常。联合治疗后1个月超声示宫腔内膜线清晰,未见病灶残留复发;29例均于治疗1.0~1.5个月后恢复月经周期。结论MTX UACE联合清宫术治疗CSP有效且安全。
Objective To investigate the efficacy and safety of methotrexate(MTX)uterine artery chemoembolization(UACE)combined with curettage for treating cesarean scar pregnancies(CSP).Methods A total of 29 CSP patients diagnosed by ultrasound and/or MRI and underwent UACE and curettage within 72 h after UACE were retrospectively collected.The therapeutic efficacy was evaluated,the amount of blood loss and gestational matter were recorded.The treatment-related complications were observed,bloodβ-human chorionic gonadotropin(β-HCG)and changes on ultrasonic images were explored after treatment,and the menstrual status was followed up.Results UACE and sequential curettage were successfully performed in all 29 cases.The amount of blood loss during curettage was 5—50 ml with a median of 10 ml,and the gestational matter was 10—100 ml with a median of 20 ml.Vagal reflex occurred in 1 case during UACE but improved after intravenous injection of 1 mg atropine.One week after UACE,post-embolization syndrome occurred in all 29 cases,which resolved after treatment with methylprednisolone.After combination treatment,bloodβ-HCG decreased from 78997.00(23150.50,201975.50)mIU/ml before treatment to 2873.00(1873.00,4182.50)mIU/ml(Z=-6.322,P=0.001).Bloodβ-HCG returned to normal 15—27 days after combination treatment,with a mean time of(20.2±3.3)days.One month after combination treatment,ultrasound showed clear endometrial line without residual recurrence of lesions.Menstruation cycle restored in all 29 cases 1.0—1.5 months after combination treatment.Conclusion MTX UACE combined with curettage was effective and safe for treating CSP.
作者
夏玲燕
吴安乐
XIA Lingyan;WU Anle(Department of Radiology,Haishu District People’s Hospital,Ningbo 315000,China;Department of Interventional Medicine,the First Affiliated Hospital of Ningbo University,Ningbo 315000,China)
出处
《中国介入影像与治疗学》
北大核心
2024年第10期592-595,共4页
Chinese Journal of Interventional Imaging and Therapy
关键词
妊娠
异位
化学栓塞
治疗性
子宫瘢痕妊娠
pregnancy,ectopic
chemoembolization,therapeutic
cesarean scar pregnancy
