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时间:2020-04-25
《介入化疗栓塞联合B超监视下清宫术治疗剖宫产瘢痕妊娠10例报告-论文.pdf》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、·1080·中国微创外科杂志2013年12月第鲞箜塑!!g!!!!望!!:!::临床论著·介入化疗栓塞联合B超监视下清宫术治疗剖宫产瘢痕妊娠1O例报告罗晓梅李青春①骆迎春②(湖南省妇幼保健院妇三科,长沙410005)【摘要】目的探讨子宫动脉化疗栓塞后在B超监视下清宫治疗剖宫产瘢痕妊娠(cesareanscarpregnancy,CSP)的临床效果。方法2012年12月~2013年4月对l0例CSP行双侧子宫动脉甲氨蝶呤灌注化疗及明胶海绵颗粒栓塞术,术后24~72h内B超监视下清宫术。结果栓塞后造影显示子宫动脉远端血流信号中断,栓塞术后无一例发
2、生异位血管栓塞、子宫坏死、局部感染等严重并发症。子宫动脉化疗栓塞后24~72h内清官,清宫时孕囊境界清楚,B超引导下均能完整顺利刮出。术中刮出组织20~100g,病理报告见变性绒毛及蜕膜组织、血块红染坏死物。术中出血10~50ml,平均23ml。手术时间15~60min,平均26min。术后均无宫内残留,无再发出血。术后血p—hCG10~21d,平均14d恢复正常;治疗后26~40d月经来潮,未出现闭经等卵巢早衰症状。结论子宫动脉化疗栓塞联合超声监视下清宫术降低子宫穿孔风险,避免患者切除子宫,保留了生育能力,是治疗CSP安全有效、创伤小、并发
3、症少的方法,具有较高的临床应用价值。【关键词】化疗栓塞;清宫术;剖宫产瘢痕妊娠中图分类号:R7l3.8文献标识:A文章编号:1009—6604(2013)12—1080—04UterineArteryChemoembolizationCombinedwithUterineCurettageUnderUltrasonicMonitoringforCesareanScarPregnancy:aReportof10CasesLuoXiaomei,LiQingchun,LuoYingchun.The3rdDepartmentofGynecology,
4、Hu’nanMaternalandChildHealthHospital,Changsha410005,China【Abstract】0bjectiveToevaluatetheclinicaleffectofuterinecurettageunderultrasonicguidancefollowinguterinearterychemoembolizationforthetreatmentofcesareanscarpregnancy(CSP).MethodsTenpatientswithCSPwereperformedbilateral
5、uterinearterychemoembolizationusingmethotrexateandgelatinspongeparticlesfromDecember2012toApril2013.Uterinecurettageunderultrasonicmonitoringwascarriedout24to72hoursafterchemoembolization.ResultsA1lthe10caseswentthroughbilateraluterinearterychemoembolizationsuccessfully,and
6、nocomplicationssuchasuterineavascularnecrosis,ectopicvesselembolismandlocalinfectionoccurred.Angiogrophyafterembolizationshowedthatbloodflowsignalinuterinearterydistalwasinterrupted.Uterinecurettagewasperformedsuccessfully24—72hoursaftertheimplementationofchemoembolization.
7、Pregnantbursawasshownclearlybyultrasonography.Scrapedtissuesweighed2—100g.Pathologicalexaminationshoweddegenerativechorionanddeciduatissues,andsphacelusdyedbyblood.Theintraoperativebloodlosswas10—50ml,withanaverageof23m1.Theoperationtimewas15—60min,withanaverageof26min.Nopo
8、stoperativeresidueintheurterusorrecurrentbleedingwasfound.SerumB—hCGdroppedsignifi
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