宫腔镜联合动脉栓塞治疗特殊类型异位妊娠的临床应用
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摘要
目的:探讨宫腔镜联合动脉栓塞在特殊类型异位妊娠治疗中的应用价值。方法:对23例诊断明确的特殊类型异位妊娠患者(宫颈妊娠9例,剖宫产后子宫瘢痕部位妊娠14例)行宫腔镜下刮宫或清宫等手术治疗,术前1～3天行双侧子宫动脉栓塞。结果:23例患者共成功栓塞45根子宫动脉,栓塞后均在宫腔镜下行刮宫或清宫术,胚胎组织易于剥离,术中平均出血35 mL。所有患者术后2.5周血β-HCG恢复正常,1～3个月月经恢复正常。结论:子宫动脉栓塞对特殊类型异位妊娠止血疗效确切,可以为宫腔镜提供安全保障,二者联合应用具有创伤小,出血少,手术时间短,术后恢复快,住院时间短的特点,是一种新的、安全有效、微创的保守治疗方法,值得推广应用。
Objective: To investigate the role of hysteroscopy combined with arterial embolization for the treatment of special types of ectopic pregnancy.Methods: 23 cases of special types of patients with ectopic pregnancy(cervical pregnancy in 9 cases,uterine scar after cesarean section parts in 14 cases) were received hysteroscopic curettage surgery.Bilateral uterine artery embolization were perfomed in preoperative 1 to 3 days.Results: 45 uterine arteries were all successfully embolized in 23 patients.After embolization,the hysteroscopy curettage was performed.The embryonic tissue was easy to peel,intraoperative mean blood loss was 35 mL.2.5 weeks serum β-HCG returned to normal in all patients and menstruation return to normal after 1 to 3 months.Conclusion: The hemostatic efficacy of uterine artery embolization on the special type of ectopic pregnancy was confirmed,which could provide security for hysteroscopy.Hysteroscopy combined with arterial embolization showed the advantages of less trauma,less bleeding,shorter operative time,rapid postoperative recovery and shorter hospital stay.It was a new,safe and effective,minimally invasive conservative treatment and it should be widely applied.
Objective: To investigate the role of hysteroscopy combined with arterial embolization for the treatment of special types of ectopic pregnancy.Methods: 23 cases of special types of patients with ectopic pregnancy(cervical pregnancy in 9 cases,uterine scar after cesarean section parts in 14 cases) were received hysteroscopic curettage surgery.Bilateral uterine artery embolization were perfomed in preoperative 1 to 3 days.Results: 45 uterine arteries were all successfully embolized in 23 patients.After embolization,the hysteroscopy curettage was performed.The embryonic tissue was easy to peel,intraoperative mean blood loss was 35 mL.2.5 weeks serum β-HCG returned to normal in all patients and menstruation return to normal after 1 to 3 months.Conclusion: The hemostatic efficacy of uterine artery embolization on the special type of ectopic pregnancy was confirmed,which could provide security for hysteroscopy.Hysteroscopy combined with arterial embolization showed the advantages of less trauma,less bleeding,shorter operative time,rapid postoperative recovery and shorter hospital stay.It was a new,safe and effective,minimally invasive conservative treatment and it should be widely applied.
引文
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[2]S hannon C,Brothers P,Ph ilip N,et al.Ect opic preg-nancy and medical abortion[J].Obstet Gynecol,2004,104(1):61-167.
[3]Jurkovic D,Hillaby K,Woelfer B,et al.First trimester di-agnosis and management of pregnacies implanted into thelower uterine segment cesarean section scar[J].Ultra-sound Obstet Gynecol,2003,21(3):20-227.
[4]Seow KM,Huang LW,Lin YH,et al.Cesarean scar preg-nancy:issues in management[J].Ultrasond Obstet Gyne-col,2004,23(3):247-253.
[5]Rotas MA,Haberman S,Levgur M,et al.Cesarean scar ec-topic pregnancies:etiology,diagnosis and management[J].Obstet Gynecol,2006,107(6):1373-1381.
[6]Marston LM,Dotters DJ,Katz VL,et al.Methotrexate and angi-gographic embol izition for conservative treatment of cervicalpregnancy[J].SouthMed J,1996,89(2):246-248.
[7]Ash S,Farrell SA.Hysteroscopic resection of a cervical ec-topic pregnancy[J].Fertil Steril,1996,66(5):842-844.
[8]Wang CJ,Chao AS,Yuen LT,et al.Endoscopic manage-ment of cesarean scar pregnancy[J].Fertil Steril,2006,85(2):494.