宫颈妊娠血管性介入治疗3例临床分析
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[摘要] 目的 探讨血管性介入治疗在宫颈妊娠中的应用价值。 方法 分析2010年1月～2011年12月来我院实施选择性子宫动脉甲氨蝶呤灌注冲击联合明胶海绵栓塞治疗的3例宫颈妊娠患者，术后24 h内行刮宫术，并对患者术后进行超声、血HCG、月经恢复情况、术后2年内妊娠情况随访。 结果 3例患者血管性介入治疗均获得成功，刮宫术中出血为15～50 mL，治疗前后均未发现严重的并发症，且术后血HCG值20 d内全部恢复正常；3例患者中除1例既往月经不规律术后月经未转为正常外，其余2例均恢复规律月经并成功妊娠。 结论 血管性介入治疗能明显降低宫颈妊娠刮宫术中大出血的风险，且可能并不影响患者生育功能，是一项安全且有效的宫颈妊娠保守治疗方法。
[关键词] 介入治疗；子宫动脉；宫颈妊娠
[中图分类号] R713.8 [文献标识码] A [文章编号] 1673-7210（2012）08（b）-0047-03
Clinical analysis about vascular interventional treatment in 3 cases of cervical pregnancy
LIU Qing1 WU Guixiang1 WU Zhonggen2 ZHUANG Xiaolan1
1. Department of Gynaecology and Obstetrics, the People's Hospital of Ji'an City, Jiangxi Province, Ji'an 343000, China;
2. Department of Radiation, the People's Hospital of Ji'an City, Jiangxi Province, Ji'an 343000, China
[Abstract] Objective To investigate the value of the vascular interventional therapy in cervical pregnancy. Methods 3 cases of cervical pregnancies in our hospital in the past two years were analysised, these patients were implemented the impact of methotrexate combining with gelatin sponge embolization by uterine artery infusion, the curettage carried out after surgery 24 hours, and pelvic ultrasound, blood HCG, menstruation recovery, the situation of pregnancy after surgery 2 years were followed up. Results Vascular interventions were successful in 3 patients, the bleedings were 15-50 mL in the curettages, no serious complications occurred during treatment, serum HCG of patients were decreased to normal values within 20 days after surgery. Except for 1 case due to irregular menstrual history, and the remaining 2 patients recovered regular menstruation and successfully pregnancied after 2 years. Conclusion The vascular interventional therapy can significantly reduce the risk of bleeding in the curettage of cervical pregnancy, this method may become a safe and effective conservative treatment in cervical pregnancy.
[Key words] Interventional treatment; Uterine artery; Cervical pregnancy
宫颈妊娠是一种罕见的异位妊娠，其发病率占异位妊娠的0.1%[1]，为宫内妊娠的1/（2 550～98 000）[2]。随着人工流产、剖宫产分娩的增加，以及辅助生育技术的普遍开展，宫颈妊娠发生率有增加的趋势[3-4]。宫颈妊娠虽罕见，但一旦发病则病情危重，可突然阴道大量流血而危及患者生命，传统的治疗需行子宫切除术。近年来，临床工作者们正积极探索各种安全、有效的保守治疗方案来减少阴道出血，避免切除子宫，并最终保存患者生育功能，这些方法包括：全身或羊膜腔注射甲氨蝶呤，宫颈局部注射血管收缩剂，结扎子宫、宫颈及髂内动脉，宫颈环扎缝合术，Foley导管填塞宫颈，以及子宫动脉栓塞术等[5]。本文主要报道3例我院实施选择性子宫动脉甲氨蝶呤（MTX）灌注冲击联合明胶海绵栓塞治疗的宫颈妊娠患者，探讨血管性介入治疗在宫颈妊娠中的应用价值。
1 资料与方法
1.1 一般资料
病例1：32岁女性，已婚已育，1-0-2-1（足月产1次-早产0次-流产2次-现存子女1人，简写为1-0-2-1，以下同），剖宫产史，因停经38 d，阴道不规则出血5 d入院。检查：阴道中量血污，宫颈稍大，呈紫蓝色，软。血HCG 2 324 mIU/mL。彩超表现：宫体稍大，宫腔内未见孕囊；宫颈管稍膨大，颈管内可见约1.7 cm×1.0 cm×0.8 cm不均匀囊性团块，内见卵黄囊回声，未见明显胚芽，局部周边见少许血流信号；双附件区未见异常回声。