An Xiao, Ming Xu, Li Ke, Wang Jingbing
Department of Vascular Surgery and Interventional Radiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 100 HaiNing Road, HongKou District, Shanghai 200080, China.
ScientificWorldJournal. 2013 Oct 24;2013:213603. doi: 10.1155/2013/213603. eCollection 2013.
This study observes therapeutic efficacy of uterine artery embolization combined with MTX infusion which terminates cesarean scar pregnancy (CSP) and induces three factors which probably relate to failure.
Twenty-three CSP patients were treated with combined uterine artery MTX infusion and embolization. Among them six patients with severe hemorrhage were immediately treated with interventional operation. Clinical effects were estimated by symptoms, serum β-hCG, ultrasound, and MR.
Interventional treatments were technologically successful in 22 patients except one. Immediate hemostasis was achieved in all 6 patients with massive colporrhagia. No occurrence of infection and uterine necrosis was observed, but 12 women suffered abdominal pains. Nineteen patients' uteri were preserved, whereas four underwent hysterectomy eventually.
Transcatheter arterial chemoembolization is effective to treat high-risk CSP in preference to hysterectomy. To achieve more successful outcomes, three factors should be highlighted: adequate MTX dosage, appropriate embolic material, and complete embolization of target arteries that supply blood to embryo in the scar.
本研究观察子宫动脉栓塞联合甲氨蝶呤灌注治疗剖宫产瘢痕妊娠（CSP）的疗效，并探讨可能导致治疗失败的三个因素。
对23例CSP患者采用子宫动脉甲氨蝶呤灌注联合栓塞治疗。其中6例严重出血患者立即接受介入手术治疗。通过症状、血清β-hCG、超声和磁共振成像评估临床疗效。
除1例患者外，22例患者介入治疗技术成功。6例大出血患者均立即止血。未观察到感染和子宫坏死的发生，但12例患者出现腹痛。19例患者保留了子宫，4例最终接受了子宫切除术。
经导管动脉化疗栓塞术治疗高危CSP优于子宫切除术。为获得更成功的治疗效果，应重视三个因素：足够的甲氨蝶呤剂量、合适的栓塞材料以及对瘢痕中供应胚胎血液的靶动脉进行完全栓塞。
