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目的探讨血管性介入栓塞在子宫部位异位妊娠诊治中的应用价值。方法对6例子宫部位异位妊娠(子宫肌壁间妊娠4例、宫颈妊娠、子宫瘢痕妊娠各1例)行超选择性双侧子宫动脉栓塞(UAE)+甲氨蝶呤(MTX)动脉灌注,观察其诊断符合率、治疗效果、血人绒毛膜促性腺激素(hCG)恢复至非孕水平的时间、UAE术后的副反应和并发症,随访月经恢复时间及生育情况。结果 4例怀疑肌壁间妊娠患者在UAE准备下行超声引导活检,成功取得病理组织,病理检查证实为子宫肌壁间妊娠,活检后均出现活跃出血,立即行UAE,hCG>10 kIU/L者同时予MTX动脉灌注。6例患者治疗后效果满意,hCG逐步下降至正常。随访超声均于术后2~3个月恢复正常。术后2例发生化疗Ⅰ度副反应。无1例发生近期并发症。UAE术后1~2个月恢复月经。1例患者于UAE后1年妊娠并顺利分娩。结论血管介入栓塞为易出血位置取活检提供了安全保障,有利于早期诊断特殊位置的异位妊娠,减少误诊。UAE+MTX动脉灌注治疗子宫部位异位妊娠安全有效、创伤小,避免了不必要的子宫切除术。
Objective To investigate the value of vascular interventional embolization in the diagnosis and treatment of ectopic pregnancy in the uterus. Methods Six cases of uterine ectopic pregnancy (4 cases of uterine muscular wall pregnancy, 1 case of cervical pregnancy and 1 case of uterine scar pregnancy) underwent bilateral uterine artery embolization (UAE) + methotrexate (MTX) arterial infusion The coincidence rate of diagnosis, the therapeutic effect, the time of recovery of human chorionic gonadotropin (hCG) to non-pregnant level, the side effects and complications after UAE, the time of menstruation recovery and birth were observed. Results Four cases of suspected intramuscular pregnancy were underwent ultrasound guided biopsy in UAE and pathological tissues were successfully obtained. The intrauterine pregnancy of uterine muscle was confirmed by pathology. Active bleeding occurred immediately after biopsy. Immediate UAE with hCG> 10 kIU / L At the same time to MTX artery perfusion. Six patients were treated with satisfactory results, hCG gradually decreased to normal. Follow-up ultrasound were normal after 2 to 3 months. 2 cases of postoperative chemotherapy Ⅰ degrees side effects. No one had a recent complication. UAE 1 to 2 months after menstruation resume. One patient was pregnant one year after UAE and delivered successfully. Conclusion Vascular embolization provides safeguards for biopsy at the site of hemorrhage and is conducive to the early diagnosis of ectopic pregnancy in special locations and reduces misdiagnosis. UAE + MTX arterial perfusion treatment of uterine ectopic pregnancy safe and effective, less trauma, to avoid unnecessary hysterectomy.