Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou 510080, China.
Cardiovasc Intervent Radiol. 2012 Apr;35(2):286-91. doi: 10.1007/s00270-011-0097-y. Epub 2011 Jan 27.
This study was designed to compare the effectiveness of systemic methotrexate (MTX) with uterine artery embolization (UAE) combined with local MTX for the treatment of cesarean scar pregnancy (CSP) with different ultrasonographic pattern, and to indicate the preferable therapy in CSP patients.
The results of 21 CSP cases were reviewed. All subjects were initially administrated with systemic MTX (50 mg/m(2) body surface area). UAE combined with local MTX was added to the patients who had failed systemic MTX. The transvaginal ultrasonography data were retrospectively assessed, and two different ultrasonographic patterns were found: surface implantation and deep implantation of amniotic sac. The management and its effectiveness for patients with the two ultrasonographic patterns were studied retrospectively. Ultrasound scan and serum β-hCG were monitored during follow-up. Data were analyzed with the Student's t test.
Nine patients were successfully treated with systemic MTX. The remaining 12 cases were successfully treated with additional UAE combined with local MTX. According to the classification by Vial et al. of CSP on ultrasonography, most surface implanted CSPs (8/11, 72.7%) could be successfully treated with systemic MTX, whereas most deeply implanted CSPs (9/10, 90%) had failed systemic MTX but still could be successfully treated with additional UAE combined with local MTX. All patients recovered without severe side effects. Most patients with a future desire for reproduction achieved subsequent pregnancy.
For CSP patients suitable for nonsurgical treatment, UAE combined with local MTX would be the superior option compared with systemic MTX in the cases with deep implantation of amniotic sac.
本研究旨在比较全身甲氨蝶呤（MTX）与子宫动脉栓塞术（UAE）联合局部 MTX 治疗不同超声表现的剖宫产瘢痕妊娠（CSP）的疗效，并为 CSP 患者指出更优的治疗方法。
回顾性分析 21 例 CSP 患者的临床资料。所有患者均先给予全身 MTX（50mg/m2 体表面积）治疗。对全身 MTX 治疗失败者加用 UAE 联合局部 MTX。回顾性评估经阴道超声检查资料，发现两种不同的超声表现：羊膜囊表面植入和羊膜囊深部植入。研究两种超声表现患者的治疗方法及其疗效。随访过程中监测超声检查和血清β-hCG。数据采用 Student's t 检验进行分析。
9 例患者经全身 MTX 治疗成功，12 例患者经加用 UAE 联合局部 MTX 治疗成功。根据 Vial 等对 CSP 的超声分类，大多数表面植入型 CSP（8/11，72.7%）经全身 MTX 治疗即可成功，而大多数深部植入型 CSP（9/10，90%）经全身 MTX 治疗失败，但仍可经加用 UAE 联合局部 MTX 治疗成功。所有患者均无严重不良反应恢复，大多数有生育要求的患者均获得了后续妊娠。
对于适合非手术治疗的 CSP 患者，对于羊膜囊深部植入的患者，UAE 联合局部 MTX 优于全身 MTX。
