Fornazari Vinicius Adami Vayego, Szejnfeld Denis, Elito Júnior Julio, Goldman Suzan Menasce
Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2015 Jan-Mar;13(1):167-9. doi: 10.1590/S1679-45082015MD3168.
The advent of interventional radiology enabled remarkable advances in diagnosis and treatment of several situations in obstetrics and gynecology. In the field of obstetrics, these advances include temporary occlusion of the iliac arteries to the management of placenta accreta and/or prior, arteriovenous fistulas after embolization of uterine curettage and management of ectopic uterine and extra-uterine pregnancies. The non-tubal ectopic pregnancy, either cervical, abdominal, ovarian or in a cesarean scar, often represents major therapeutic challenge, especially when exists a desire to maintain fertility. Despite the systemic methotrexate therapy and surgical resection of the ectopic gestational sac be the most used therapeutic options, the interventionist approach of non-tubal ectopic pregnancies, direct injection of methotrexate in the gestational sac and intra-arterial chemoembolization of uterine arteries constitute in the currently literature viable, safe, effective modalities with low morbidity, shorter hospital stay, and rapid clinical recovery. Because of little variety of materials used, and the increase in training of specialists in the area, the radiological intervention as a treatment option in ectopic pregnancies is financially viable and present considerable accessibility in the world and at most of Brazilian medical centers.
介入放射学的出现使妇产科多种病症的诊断和治疗取得了显著进展。在产科领域，这些进展包括通过暂时阻断髂动脉来处理胎盘植入和/或先前子宫刮宫栓塞后的动静脉瘘，以及处理子宫内和子宫外异位妊娠。非输卵管异位妊娠，无论是宫颈、腹腔、卵巢还是剖宫产瘢痕处的异位妊娠，往往都是重大的治疗挑战，尤其是当患者有保留生育能力的需求时。尽管全身甲氨蝶呤治疗和手术切除异位妊娠囊是最常用的治疗选择，但对于非输卵管异位妊娠的介入治疗方法，即向妊娠囊内直接注射甲氨蝶呤和子宫动脉内化疗栓塞，在当前文献中是可行、安全、有效的方式，具有低发病率、较短住院时间和快速临床恢复的特点。由于所用材料种类较少，且该领域专科医生培训的增加，放射介入作为异位妊娠的一种治疗选择在经济上是可行的，并且在全球和巴西的大多数医疗中心都具有相当高的可及性。
