子宫动脉栓塞术介入治疗剖宫产切口瘢痕妊娠的研究进展
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摘要
随着剖宫产率的居高不下和二胎政策的放开,剖宫产切口瘢痕妊娠(CSP)已成为严重威胁育龄妇女生命安全和导致生育能力丧失的疾病。子宫动脉栓塞术(UAE)介入治疗是用于辅助治疗CSP的微创技术,具有止血迅速、疗效确切、安全性高、可保留生育功能等优势,但随着该技术在临床的广泛应用,如何正确掌握治疗指征、技术要点及充分认识其治疗优势和局限性是决定UAE治疗成败的关键。且UAE介入治疗能否对育龄期妇女的生殖器官造成损伤和生育能力造成影响也是临床医师和患者最关心的问题,未来需进一步研究。
With the high rate of Cesarean section and the open-up of the second child policy,Cesarean scar pregnancy( CSP) has become a serious threat to the life safety of women of childbearing age and a disease leading to the loss of fertility. Uterine artery embolization( UAE) interventional therapy is a minimally invasive technique for assistant treatment of CSP. It has the advantages of rapid hemostasis,definite curative effect,high safety and reproductive function preservation.With the wide application of UAE in clinic,how to correctly grasp the treatment indications,technical points and fully understand its treatment advantages and limitations is the key to determine the success or failure of UAE treatment.Moreover,whether UAE interventional therapy can damage reproductive organs and affect reproductive ability of women of childbearing age is also the most concerned issue for the clinicians and patients,and further research is needed in the future.
With the high rate of Cesarean section and the open-up of the second child policy,Cesarean scar pregnancy( CSP) has become a serious threat to the life safety of women of childbearing age and a disease leading to the loss of fertility. Uterine artery embolization( UAE) interventional therapy is a minimally invasive technique for assistant treatment of CSP. It has the advantages of rapid hemostasis,definite curative effect,high safety and reproductive function preservation.With the wide application of UAE in clinic,how to correctly grasp the treatment indications,technical points and fully understand its treatment advantages and limitations is the key to determine the success or failure of UAE treatment.Moreover,whether UAE interventional therapy can damage reproductive organs and affect reproductive ability of women of childbearing age is also the most concerned issue for the clinicians and patients,and further research is needed in the future.
引文
[1]Qiao B,Zhang Z,Li Y.Uterine artery embolization versus methotrexate for cesarean scar pregnancy in a Chinese population:Ameta-analysis[J].J Minim Invasive Gynecol,2016,23(7):1040-1048.
[2]Birge,Karaca C,Arslan D,et al.Medical management of cesarean scar pregnancy at advanced age:Case report and literature review[J].Clin Exp Obstet Gynecol,2016,43(1):140-142.
[3]Ou Yang Z,Yin Q,Xu Y,et al.Heterotopic cesarean scar pregnancy:Diagnosis,treatment,and prognosis[J].J Ultrasound Med,2014,33(9):1533-1537.
[4]Singhal S,Singh A,Raghunandan C,et al.Uterine artery embolization:Exploring new dimensions in obstetric emergencies[J].Oman Med J,2014,29(3):217-219.
[5]Rotas MA,Haberman S,Levgur M.Cesarean scar ectopic pregnancies:Etiology,diagnosis,and management[J].Obstet Gynecol,2006,107(6):1373-1381.
[6]Peng KW,Lei Z,Xiao TH,et al.First trimester caesarean scar ectopic pregnancy evaluation using MRI[J].Clin Radiol,2014,69(2):123-129.
[7]Hegde CV.Cesarean scar pregnancy:Some management options[J].J Obstet Gynaecol India,2017,67(3):153-156.
[8]Vial Y,Petignat P,Hohlfeld P.Pregnancy in a cesarean scar[J].Ultrasound Obstet Gynecol,2000,16(6):592-593.
[9]中华医学会妇产科学分会计划生育学组.剖宫产术后子宫瘢痕妊娠诊治专家共识(2016)[J].中华妇产科杂志,2016,51(8):568-572.
[10]Hong Y,Guo Q,Pu Y,et al.Outcome of high-intensity focused ultrasound and uterine artery embolization in the treatment and management of cesarean scar pregnancy:A retrospective study[J].Medicine(Baltimore),2017,96(30):e7687.
[11]Ma Y,Yang C,Shao X.Efficacy comparison of transcatheter arterial embolization with gelatin sponge and polyvinyl alcohol particles for the management of cesarean scar pregnancy and follow-up study[J].J Obstet Gynaecol Res,2017,43(4):682-688.
[12]Sun YY,Xi XW,Yan Q,et al.Management of typeⅡunruptured cesarean scar pregnancy:Comparison of gestational mass excision and uterine artery embolization combined with methotrexate[J].Taiwan J Obstet Gynecol,2015,54(5):489-492.
[13]Shafqat G,Khandwala K,Iqbal H,et al.Cesarean scar pregnancy:An experience of three cases with review of literature[J].Cureus,2018,10(2):e2133.
[14]Cao GS,Liu RQ,Liu YY,et al.Menstruation recovery in scar pregnancy patients undergoing UAE and curettage and its influencing factors[J].Medicine(Baltimore),2018,97(11):e9584.
[15]刘津华,张磊,穆永旭.明胶海绵颗粒和聚乙烯醇颗粒治疗瘢痕妊娠的临床效果比较[J/CD].中华介入放射学电子杂志,2018,6(1):51-54.
[16]Feng Y,Chen S,Li C,et al.Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy[J].Exp Ther Med,2016,12(3):1469-1475.
[17]Giampaolino P,De Rosa N,Morra I,et al.Management of cesarean scar pregnancy:A single-institution retrospective review[J].Biomed Res Int,2018,2018:6486407.
[18]Gao J,Li X,Chen J,et al.Uterine artery embolization combined with local infusion of methotrexate and 5-fluorouracil in treating ectopic pregnancy:A CONSORT-compliant article[J].Medicine(Baltimore),2018,97(5):e9722.
[19]Cao S,Zhu L,Jin L,et al.Uterine artery embolization in cesarean scar pregnancy:Safe and effective intervention[J].Chin Med J(Engl),2014,127(12):2322-2326.
[20]Chen H,Zhou J,Wang H,et al.The treatment of cesarean scar pregnancy with uterine artery embolization and curettage as compared to transvaginal hysterotomy[J].Eur J Obstet Gynecol Reprod Biol,2017,214(7):44-49.
[21]Bayoglu Tekin Y,Mete Ural U,Balk G,et al.Management of cesarean scar pregnancy with suction curettage:A report of four cases and review of the literature[J].Arch Gynecol Obstet,2014,289(6):1171-1175.
[22]Zhang B,Jiang ZB,Huang MS,et al.Uterine artery embolization combined with methotrexate in the treatment of cesarean scar pregnancy:Results of a case series and review of the literature[J].J Vasc Interv Radiol,2012,23(12):1582-1588.
[23]An X,Ming X,Li K,et al.The analysis of efficacy and failure factors of uterine artery methotrexate infusion and embolization in treatment of cesarean scar pregnancy[J].Scientific World J,2013,2013:213603.
[24]Liu J,Chai Y,Yu Y,et al.The value of 3-dimensional color Doppler in predicting intraoperative hemorrhage for cesarean scar pregnancy[J].Medicine(Baltimore),2018,97(33):e11969.
[25]Qiu J,Fu Y,Xu J,et al.Analysis on clinical effects of dilation and curettage guided by ultrasonography versus hysteroscopy after uterine artery embolization in the treatment of cesarean scar pregnancy[J].Ther Clin Risk Manag,2019,15(1):83-89.
[26]Huang Y,Li Y,Xi R,et al.An application of uterine artery chemoembolization in treating cesarean scar pregnancy[J].Int J Clin Exp Med,2015,8(2):2570-2577.
[27]朱志韬,孙志先,祖茂衡,等.子宫动脉栓塞术预防疤痕妊娠清宫大出血的临床价值[J/CD].中华介入放射学电子杂志,2017,5(1):13-16.
[28]Liu W,Shen L,Wang Q,et al.Uterine artery embolization combined with curettage vs methotrexate plus curettage for cesarean scar pregnancy[J].Arch Gynecol Obstet,2016,294(1):71-76.
[29]Fu LP.Therapeutic approach for the cesarean scar pregnancy[J].Medicine(Baltimore),2018,97(18):e0476.
[30]Birch Petersen K,Hoffmann E,Rifbjerg Larsen C,et al.Cesarean scar pregnancy:A systematic review of treatment studies[J].Fertil Steril,2016,105(4):958-967.
[31]Li Y,Wang W,Yang T,et al.Incorporating uterine artery embolization in the treatment of cesarean scar pregnancy following diagnostic ultrasonography[J].Int J Gynaecol Obstet,2016,134(2):202-207.
[32]Wu X,Xue X,Wu X,et al.Combined laparoscopy and hysteroscopy vs.uterine curettage in the uterine artery embolization-based management of cesarean scar pregnancy:A cohort study[J].Int J Clin Exp Med,2014,7(9):2793-2803.
[33]Du YJ,Zhang XH,Wang LQ.Risk factors for haemorrhage during suction curettage after uterine artery embolization for treating caesarean scar pregnancy:A case-control study[J].Gynecol Obstet Invest,2015,80(4):259-264.
[34]Guo J,Yu J,Zhang Q,et al.Clinical efficacy and safety of uterine artery embolization(UAE)versus laparoscopic cesarean scar pregnancy debridement surgery(LCSPDS)in treatment of cesarean scar pregnancy[J].Med Sci Monit,2018,24(7):4659-4666.
[35]Li J,Li X,Yu H,et al.Combined laparoscopic and hysteroscopic management of cesarean scar pregnancy with temporary occlusion of bilateral internal iliac arteries[J].Medicine(Baltimore),2018,97(32):e11811.
[36]Qiu J,Fu Y,Huang X,et al.Acute pulmonary embolism in a patient with cesarean scar pregnancy after receiving uterine artery embolization:A case report[J].Ther Clin Risk Manag,2018,14(1):117-120.
[37]Salazar GM,Gregory Walker T,Conway RF,et al.Embolization of angiographically visible typeⅠandⅡutero-ovarian anastomoses during uterine artery embolization for fibroid tumors:Impact onsymptom recurrence and permanent amenorrhea[J].J Vasc Interv Radiol,2013,24(9):1347-1352.
[38]聂东云,陈素文.子宫动脉栓塞介入治疗对不同年龄段剖宫产瘢痕妊娠患者的影响[J].中国计划生育学杂志,2017,25(7):463-466.
[39]Moss J,Christie A.Uterine artery embolization for heavy menstrual bleeding[J].Womens Health(Lond),2016,12(1):71-77.
[40]Tumenjargal A,Tokue H,Kishi H,et al.Uterine artery embolization combined with dilation and curettage for the treatment of cesarean scar pregnancy:Efficacy and future fertility[J].Cardiovasc Intervent Radiol,2018,41(8):1165-1173.
[41]Pedraszewski P,Wla lak E,Panek W,et al.Cesarean scar pregnancy-a new challenge for obstetricians[J].J Ultrason,2018,18(72):56-62.
[42]Docheva N,Slutsky ED,Borella N,et al.The rising triad of cesarean scar pregnancy,placenta percreta,and uterine rupture:Acase report and comprehensive review of the literature[J].Case Rep Obstet Gynecol,2018,2018:8797643.
[43]Wang Q,Peng HL,He L,et al.Reproductive outcomes after previous cesarean scar pregnancy:Follow up of 189 women[J].Taiwan J Obstet Gynecol,2015,54(5):551-553.
[44]Krissi H,Hiersch L,Stolovitch N,et al.Outcome,complications and future fertility in women treated with uterine artery embolization and methotrexate for non-tubal ectopic pregnancy[J].Eur JObstet Gynecol Reprod Biol,2014,182:172-176.
[2]Birge,Karaca C,Arslan D,et al.Medical management of cesarean scar pregnancy at advanced age:Case report and literature review[J].Clin Exp Obstet Gynecol,2016,43(1):140-142.
[3]Ou Yang Z,Yin Q,Xu Y,et al.Heterotopic cesarean scar pregnancy:Diagnosis,treatment,and prognosis[J].J Ultrasound Med,2014,33(9):1533-1537.
[4]Singhal S,Singh A,Raghunandan C,et al.Uterine artery embolization:Exploring new dimensions in obstetric emergencies[J].Oman Med J,2014,29(3):217-219.
[5]Rotas MA,Haberman S,Levgur M.Cesarean scar ectopic pregnancies:Etiology,diagnosis,and management[J].Obstet Gynecol,2006,107(6):1373-1381.
[6]Peng KW,Lei Z,Xiao TH,et al.First trimester caesarean scar ectopic pregnancy evaluation using MRI[J].Clin Radiol,2014,69(2):123-129.
[7]Hegde CV.Cesarean scar pregnancy:Some management options[J].J Obstet Gynaecol India,2017,67(3):153-156.
[8]Vial Y,Petignat P,Hohlfeld P.Pregnancy in a cesarean scar[J].Ultrasound Obstet Gynecol,2000,16(6):592-593.
[9]中华医学会妇产科学分会计划生育学组.剖宫产术后子宫瘢痕妊娠诊治专家共识(2016)[J].中华妇产科杂志,2016,51(8):568-572.
[10]Hong Y,Guo Q,Pu Y,et al.Outcome of high-intensity focused ultrasound and uterine artery embolization in the treatment and management of cesarean scar pregnancy:A retrospective study[J].Medicine(Baltimore),2017,96(30):e7687.
[11]Ma Y,Yang C,Shao X.Efficacy comparison of transcatheter arterial embolization with gelatin sponge and polyvinyl alcohol particles for the management of cesarean scar pregnancy and follow-up study[J].J Obstet Gynaecol Res,2017,43(4):682-688.
[12]Sun YY,Xi XW,Yan Q,et al.Management of typeⅡunruptured cesarean scar pregnancy:Comparison of gestational mass excision and uterine artery embolization combined with methotrexate[J].Taiwan J Obstet Gynecol,2015,54(5):489-492.
[13]Shafqat G,Khandwala K,Iqbal H,et al.Cesarean scar pregnancy:An experience of three cases with review of literature[J].Cureus,2018,10(2):e2133.
[14]Cao GS,Liu RQ,Liu YY,et al.Menstruation recovery in scar pregnancy patients undergoing UAE and curettage and its influencing factors[J].Medicine(Baltimore),2018,97(11):e9584.
[15]刘津华,张磊,穆永旭.明胶海绵颗粒和聚乙烯醇颗粒治疗瘢痕妊娠的临床效果比较[J/CD].中华介入放射学电子杂志,2018,6(1):51-54.
[16]Feng Y,Chen S,Li C,et al.Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy[J].Exp Ther Med,2016,12(3):1469-1475.
[17]Giampaolino P,De Rosa N,Morra I,et al.Management of cesarean scar pregnancy:A single-institution retrospective review[J].Biomed Res Int,2018,2018:6486407.
[18]Gao J,Li X,Chen J,et al.Uterine artery embolization combined with local infusion of methotrexate and 5-fluorouracil in treating ectopic pregnancy:A CONSORT-compliant article[J].Medicine(Baltimore),2018,97(5):e9722.
[19]Cao S,Zhu L,Jin L,et al.Uterine artery embolization in cesarean scar pregnancy:Safe and effective intervention[J].Chin Med J(Engl),2014,127(12):2322-2326.
[20]Chen H,Zhou J,Wang H,et al.The treatment of cesarean scar pregnancy with uterine artery embolization and curettage as compared to transvaginal hysterotomy[J].Eur J Obstet Gynecol Reprod Biol,2017,214(7):44-49.
[21]Bayoglu Tekin Y,Mete Ural U,Balk G,et al.Management of cesarean scar pregnancy with suction curettage:A report of four cases and review of the literature[J].Arch Gynecol Obstet,2014,289(6):1171-1175.
[22]Zhang B,Jiang ZB,Huang MS,et al.Uterine artery embolization combined with methotrexate in the treatment of cesarean scar pregnancy:Results of a case series and review of the literature[J].J Vasc Interv Radiol,2012,23(12):1582-1588.
[23]An X,Ming X,Li K,et al.The analysis of efficacy and failure factors of uterine artery methotrexate infusion and embolization in treatment of cesarean scar pregnancy[J].Scientific World J,2013,2013:213603.
[24]Liu J,Chai Y,Yu Y,et al.The value of 3-dimensional color Doppler in predicting intraoperative hemorrhage for cesarean scar pregnancy[J].Medicine(Baltimore),2018,97(33):e11969.
[25]Qiu J,Fu Y,Xu J,et al.Analysis on clinical effects of dilation and curettage guided by ultrasonography versus hysteroscopy after uterine artery embolization in the treatment of cesarean scar pregnancy[J].Ther Clin Risk Manag,2019,15(1):83-89.
[26]Huang Y,Li Y,Xi R,et al.An application of uterine artery chemoembolization in treating cesarean scar pregnancy[J].Int J Clin Exp Med,2015,8(2):2570-2577.
[27]朱志韬,孙志先,祖茂衡,等.子宫动脉栓塞术预防疤痕妊娠清宫大出血的临床价值[J/CD].中华介入放射学电子杂志,2017,5(1):13-16.
[28]Liu W,Shen L,Wang Q,et al.Uterine artery embolization combined with curettage vs methotrexate plus curettage for cesarean scar pregnancy[J].Arch Gynecol Obstet,2016,294(1):71-76.
[29]Fu LP.Therapeutic approach for the cesarean scar pregnancy[J].Medicine(Baltimore),2018,97(18):e0476.
[30]Birch Petersen K,Hoffmann E,Rifbjerg Larsen C,et al.Cesarean scar pregnancy:A systematic review of treatment studies[J].Fertil Steril,2016,105(4):958-967.
[31]Li Y,Wang W,Yang T,et al.Incorporating uterine artery embolization in the treatment of cesarean scar pregnancy following diagnostic ultrasonography[J].Int J Gynaecol Obstet,2016,134(2):202-207.
[32]Wu X,Xue X,Wu X,et al.Combined laparoscopy and hysteroscopy vs.uterine curettage in the uterine artery embolization-based management of cesarean scar pregnancy:A cohort study[J].Int J Clin Exp Med,2014,7(9):2793-2803.
[33]Du YJ,Zhang XH,Wang LQ.Risk factors for haemorrhage during suction curettage after uterine artery embolization for treating caesarean scar pregnancy:A case-control study[J].Gynecol Obstet Invest,2015,80(4):259-264.
[34]Guo J,Yu J,Zhang Q,et al.Clinical efficacy and safety of uterine artery embolization(UAE)versus laparoscopic cesarean scar pregnancy debridement surgery(LCSPDS)in treatment of cesarean scar pregnancy[J].Med Sci Monit,2018,24(7):4659-4666.
[35]Li J,Li X,Yu H,et al.Combined laparoscopic and hysteroscopic management of cesarean scar pregnancy with temporary occlusion of bilateral internal iliac arteries[J].Medicine(Baltimore),2018,97(32):e11811.
[36]Qiu J,Fu Y,Huang X,et al.Acute pulmonary embolism in a patient with cesarean scar pregnancy after receiving uterine artery embolization:A case report[J].Ther Clin Risk Manag,2018,14(1):117-120.
[37]Salazar GM,Gregory Walker T,Conway RF,et al.Embolization of angiographically visible typeⅠandⅡutero-ovarian anastomoses during uterine artery embolization for fibroid tumors:Impact onsymptom recurrence and permanent amenorrhea[J].J Vasc Interv Radiol,2013,24(9):1347-1352.
[38]聂东云,陈素文.子宫动脉栓塞介入治疗对不同年龄段剖宫产瘢痕妊娠患者的影响[J].中国计划生育学杂志,2017,25(7):463-466.
[39]Moss J,Christie A.Uterine artery embolization for heavy menstrual bleeding[J].Womens Health(Lond),2016,12(1):71-77.
[40]Tumenjargal A,Tokue H,Kishi H,et al.Uterine artery embolization combined with dilation and curettage for the treatment of cesarean scar pregnancy:Efficacy and future fertility[J].Cardiovasc Intervent Radiol,2018,41(8):1165-1173.
[41]Pedraszewski P,Wla lak E,Panek W,et al.Cesarean scar pregnancy-a new challenge for obstetricians[J].J Ultrason,2018,18(72):56-62.
[42]Docheva N,Slutsky ED,Borella N,et al.The rising triad of cesarean scar pregnancy,placenta percreta,and uterine rupture:Acase report and comprehensive review of the literature[J].Case Rep Obstet Gynecol,2018,2018:8797643.
[43]Wang Q,Peng HL,He L,et al.Reproductive outcomes after previous cesarean scar pregnancy:Follow up of 189 women[J].Taiwan J Obstet Gynecol,2015,54(5):551-553.
[44]Krissi H,Hiersch L,Stolovitch N,et al.Outcome,complications and future fertility in women treated with uterine artery embolization and methotrexate for non-tubal ectopic pregnancy[J].Eur JObstet Gynecol Reprod Biol,2014,182:172-176.