Zhang X-B, Zhong Y-C, Chi J-C, Shen J-L, Qiu X-X, Xu J-R, Zhao A-M, Di W
Department of Interventional Radiology, Renji Hospital, Shanghai JiaoTong University Medical School, Shanghai, China.
J Int Med Res. 2012;40(5):1919-30. doi: 10.1177/030006051204000533.
This study investigated bilateral uterine artery chemoembolization (BUACE) combined with dilation and curettage (D&C) in caesarean scar pregnancy (CSP).
Nineteen women with CSP were referred for interventional radiology. In 13 patients, BUACE was performed before D&C, following a diagnosis of CSP. A further six patients received BUACE for massive vaginal bleeding after D&C for inevitable miscarriage; the diagnosis of CSP was subsequently confirmed ultrasonographically. BUACE of the uterine arteries was performed using gelfoam particles following intra-arterial infusion of 100 mg/m(2) methotrexate.
BUACE was technically successful and immediate haemostasis was achieved in all patients. Blood loss was significantly greater during D&C undertaken before BUACE compared with D&C after BUACE, but this bleeding was controlled by BUACE. No patient required further surgical intervention and there were no severe complications. The gestational sac and placenta could no longer be detected ultrasonographically and the menstrual cycle returned to normal 2-3 months after treatment in all patients.
BUACE followed by D&C seems to be a safe and effective treatment for CSP and should be considered as a treatment of choice.
本研究探讨双侧子宫动脉化疗栓塞术（BUACE）联合刮宫术（D&C）治疗剖宫产瘢痕妊娠（CSP）。
19例CSP患者被转诊至介入放射科。13例患者在诊断为CSP后，于刮宫术前进行双侧子宫动脉化疗栓塞术。另外6例患者在因难免流产行刮宫术后出现大量阴道出血，随后接受双侧子宫动脉化疗栓塞术；随后经超声检查确诊为CSP。在动脉内注入100mg/m²甲氨蝶呤后，使用明胶海绵颗粒对子宫动脉进行双侧子宫动脉化疗栓塞术。
双侧子宫动脉化疗栓塞术技术上成功，所有患者均立即止血。与双侧子宫动脉化疗栓塞术后刮宫相比，双侧子宫动脉化疗栓塞术前刮宫时的失血量明显更大，但这种出血通过双侧子宫动脉化疗栓塞术得到控制。无患者需要进一步手术干预，也无严重并发症。所有患者治疗后2 - 3个月，超声检查不再能检测到妊娠囊和胎盘，月经周期恢复正常。
双侧子宫动脉化疗栓塞术联合刮宫术似乎是一种治疗剖宫产瘢痕妊娠安全有效的方法，应被视为首选治疗方法。
