摘要
目的探讨子宫动脉灌注栓塞术(UAE)和肌内注射甲氨蝶呤(MTX)保守治疗胎盘植入的临床治疗效果。方法将我院2005年2月到2009年12月间16例胎盘植入患者分为两组,A组(介入治疗组)8例患者产后采用双侧子宫动脉灌注MTX及抗生素并栓塞动脉,术后7 d内B超监视下清除宫内残留胎盘;B组(药物治疗组)8例患者在产后给予MTX肌内注射,之后在B超监视下分次刮宫,两组均待阴道流血停止后出院,门诊B超随访胎盘组织排出情况和血清β-hCG。结果 A组8例,行子宫动脉灌注栓塞术均一次性成功,均保留子宫,平均止血时间(26.0±6.4)min,平均手术时间(46.4±7.5)min,术后3～7 d内血清β-hCG均下降至正常范围,平均(5.6±0.6)d,术后5～10 d内成功清除宫内胎盘组织,平均为(7.2±0.7)d,无宫腔感染及粘连发生,随访4例产后哺乳者,停止哺乳后1～3个月内月经恢复,另外4例患者未哺乳者,产后3个月内恢复规律月经,月经周期均规则,经量如常。B组共8例,产后予MTX肌肉注射,因治疗失败大出血切除子宫2例,平均止血时间为(28.1±5.5)d(除外失败病例),平均治疗时间为(10.5±2.5)d,血清β-hCG降至正常范围平均需(75.1±12.6)d,发生宫腔感染2例,术后宫腔粘连3例,宫腔胎盘组织完全清除平均需(104.9±9.4)d,随访6例均未哺乳,3例产后3个月内月经恢复,其中2例月经恢复正常,其余3例产后4个月月经周期正常,但经量减少。结论双侧子宫动脉灌注栓塞术治疗胎盘植入具有止血快、治疗时间短、并发症少且能保留子宫,不降低患者后续生活质量等优点,是一种高效、微创的治疗方法。
Objective To evaluate uterine arterial methotrexate（MTX） infusion together with embolization in treating placenta percreta,and to compare its result with that by using intramuscular injection of MTX.Methods Sixteen postpartum patients with placenta precreta encountered in author＇s hospital during the period of Feb.2005 to Dec.2009 were enrolled in this study.The patients were divided into two groups.Patients in group A（n = 8） received uterine arterial MTX infusion together with embolization,which was followed by uterine curettage in 7 days after the procedure under the monitoring of Doppler B-ultrasound to clean up the residual placenta.Patients in group B received pure intramuscular injection of MTX,which was followed by uterine curettage as patients in group A.All the patients were not discharged until the virginal bleeding stopped.The serum level of β-human chorionic gonadotropin（β-hCG） and the residual placenta tissue in uterine cavity were followed up.The results were compared between two groups.Results Technical success with single catheterization was obtained in all eight patients in group A.The average time for hemostasis was（26.0 ± 6.4） minutes and the average operation time was（46.4 ± 7.5） minutes.The serum β-hCG decreased to normal range within 3-7 days after the treatment,with a mean of（5.6 ± 0.6） days.The placenta tissue was successfully cleaned up by uterine curettage within 5-10 days,with a mean of（7.2 ± 0.7） days.No uterine infection and uterine cavity adherence occurred.The menses returned to regular cycle in 4 patients after they stopped breast-feeding in 1-3 months,in another 4 patients their menses regained normal within 3 months.Two patients in group B had to receive hysterectomy because of massive bleeding due to failure to intramuscular injection of MTX.The average time for hemostasis was（28.1 ± 5.5） days and the average treatment time was（10.5 ± 2.5） days.The serum β-hCG decreased to normal range in（75.1 ± 12.6） days after the treatment.Uterine cavity infection occurred in two cases and uterine cavity adhesion in three cases.The average time for complete cleaning of placenta tissue by uterine curettage was（104.9 ± 9.4） days.Six patients were followed up,all of them didn＇t feed baby after delivery.The menses returned in 3 cases within 1-3 months after delivery,two of them the menses regained normal regular cycle.The remaining three cases got their normal menses in about 4 months after delivery although the flow of menstrual cycle was scanty.Conclusion For the treatment of placenta percreta,bilateral uterine artery MTX infusion together with embolization is an effective and minimally-invasive technique with many advantages.It can stop bleeding quickly,shorten the treatment time and preserve the uterus,moreover,it carries fewer complications and can keep the patient＇s living quality in the years to come.
出处
《介入放射学杂志》
CSCD
北大核心
2010年第12期982-985,共4页
Journal of Interventional Radiology
关键词
胎盘植入
栓塞
子宫动脉
placenta percreta
embolization
uterine artery
作者简介
通信作者：倪才方
