【摘要】 目的 探討子宮部位異位妊娠的臨床特征和處理對策。 方法 回顧分析2002年9月-2009年9月間收治的31例子宮部位異位妊娠患者的臨床資料。 結果 31例患者中，初診確診僅8例，誤診率74.2%。除5例因難以控制的大出血行經腹病灶清除術加子宮修補術或全子宮切除術外，其余26例患者均經氨甲喋呤（MTX）治療加清宮術或宮腔鏡下病灶清除術保守治療成功。 結論 子宮部位異位妊娠容易誤診，超聲檢查是診斷的主要方法。保守治療安全、有效，可保留生育能力。氨甲喋呤治療加清宮術可作為治療子宮部位異位妊娠的主要方法。【Abstract】 Objective To investigate the clinical characteristics and treatment of ectopic pregnancy in the uterus. Methods The clinical data of 31 patients diagnosed as ectopic pregnancy from September 2002 to September 2009 were analyzed retrospectively. Results During preliminary diagnosis, only eight patients were accurately diagnosed.The error rate of first diagnosis was 74.2%. Five patients suffered focal cleaning and uterus neoplasty or total hysterectomy due to uncontrollable bleeding.The other 26 patients were successfully cured by conservation treatment of methotrexate (MTX) combined with dilatation and curettage or clearance of focal lesion under hysteroscopy. Conclusion Misdiagnosis of ectopic pregnancy in the uterus is easy to make.The ultrasonography is the main method for the diagnosis of ectopic pregnancy in the uterus.Conservative treatment is proved to be safe and effective and can preserve the patients’ fertility. Administration of MTX combined with dilatation and curettage is an main therapeutic method in handling ectopic pregnancy in the uterus.
【摘要】 目的 探討雙側子宮動脈化療栓塞術治療剖宮產子宮切口妊娠的臨床應用價值。 方法 2004年3月-2009年10月確診剖宮產子宮切口妊娠的患者25例。首先行雙側子宮動脈超選擇插管，注入甲氨喋嶺，再用明膠海綿條栓塞雙側子宮動脈，48~72 h內在B型超聲監測下行清宮術。 結果 25例子宮動脈化療栓塞術后復查B型超聲，提示孕囊血供明顯減少。22例在B型超聲監測下一次性清除胚胎組織，出血量少；2例因胚胎植入肌層突向漿膜層栓塞術后加用氟尿嘧啶，未行清宮，自行排出；1例因術后切口處形成大血腫行手術治療。 結論 雙側子宮動脈化療栓塞術是治療剖宮產子宮切口妊娠一種有效方法，既保留子宮，又保留其生育功能。【Abstract】 Objective To evaluate the application of bilateral uterine artery chemoembolization for caesarean scar pregnancy (CSP）. Methods A total of 25 patients with CSP From March 2004 to October 2009 were selected. Bilateral uterine artery super selective catheterization was performed after injection with methotrexate, and gelatin sponge granules were injected into blateral uterine artery. Then atificial abortion was performed under B-ultrasonic scanning within 48-72 hours. Results In all 25 cases, the blood flow of the embryo decreased significantly after uterine artery chemoembolization. A total of 22 patients received artificial abortion successfully with little vaginal bleeding;two pateints received medication with 5-FU duet to the embryo near to the perimetrium, and finally the embryo expulsed spontaneously;one patient underwent hysterectomy, because a huge hematoma was formed at the incision of the uterus after uterine artery chemoembolization. Conclusion Bilateral uterine artery chemoembolization is effective for CSP, which could keep the uterus and the patients’ reproductive function.
