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(1.Department of Radiology, 3.Department of Gynecology, the Maternal and Child Care ServiceCenter of Xiangtang County, Xiangtang 411228, China; 2.Department of Radiology,the People's Hospital of Xiangtan County, Xiangtang 411228, China; 4.Department ofInterventional Therapy, Beijing Shijitan Hospital, CapitalMedical University, Beijing 100038, China)



Termination of non-acute bleeding cesarean scar pregnancy with arterial infusion and embolization with low-dosage methotrexate at constant speed

LIUMingli1,LIUZhihua2,TANYing3,FUGuoping1,KUANGMingtao1,YUEZhendong4*

(1.DepartmentofRadiology, 3.DepartmentofGynecology,theMaternalandChildCareServiceCenterofXiangtangCounty,Xiangtang411228,China; 2.DepartmentofRadiology,thePeople'sHospitalofXiangtanCounty,Xiangtang411228,China; 4.DepartmentofInterventionalTherapy,BeijingShijitanHospital,CapitalMedicalUniversity,Beijing100038,China)

ObjectiveTo discuss the application values of arterial infusion and embolization with low-dosage Methotrexate (MTX) at constant speed in termination of non-acute bleeding cesarean scar pregnancy (CSP). MethodsA total of 47 non-acute bleeding CSP patients, who were clearly diagnosed, effectively treated with MTX arterial infusion and embolism and successfully received complete curettage of uterine cavity, were retrospectively analyzed. Among all the patients, 22 patients (group A) were treated with arterial infusion and embolism with conventional dosage in an artificial rate, and 25 patients (group B) received arterial infusion and embolism with low-dosage MTX at constant speed. Administered dosages of MTX, perfusion time, blood β-human chorionic gonadotropin (β-HCG) 3 days post-operative, blood β-HCG recovery time, recovery time of menstruation, amount of bleeding during curettage were analyzed between the two groups. ResultsCompared with A group, administered dosages of MTX was significantly lower, perfusion time was longer, blood β-HCG 3 days post-operative decreased significantly and durations for postoperative recover was obviously shorter, the amount of bleeding during curettage decreased in group B, which all had significant differences (allP<0.05). ConclusionArterial infusion and embolism with low-dosage MTX at constant speed can significantly reduce administered dosage of MTX in terminations of non-acute bleeding CSP, which is a safe and effective therapy method.

Cesarean section; Pregnancy; Uterine artery; Embolization, therapeutic; Methotrexate

剖宫产术后子宫瘢痕妊娠(caesarean scar pregnancy, CSP)是一种少见的异位妊娠，随着剖宫产率的增加，CSP的发生率明显上升[1]，继续妊娠极易发生子宫破裂，出现大出血危及生命。目前介入治疗CSP的方式很多，但多采用氨甲蝶呤(methotrexate, MTX)动脉灌注栓塞术，临床效果满意[2]。本研究回顾性分析经导管匀速低剂量及人工手动常规剂量MTX动脉灌注栓塞治疗有效，且成功接受清宫术的非急性出血CSP患者47例，比较两种方式在CSP患者术后血人绒毛膜促性腺激素(β-human chorionic gonadotropin， β-HCG)下降及恢复正常时间、清宫术中出血量及术后月经恢复时间。

1　资料与方法

1.1一般资料回顾性分析2011年3月—2015年9月经超声及宫腔镜检查确诊的非急性出血CSP、经导管MTX动脉灌注栓塞术有效，且成功接受清宫术患者47例，其中2011年3月—2013年8月22例患者接受人工手动常规剂量MTX动脉灌注栓塞术(A组)，2013年9月—2015年9月25例患者接受匀速低剂量MTX动脉灌注栓塞术(B组)。A、B两组患者临床一般资料见表1。

1.2方法对所有患者均完善相关术前准备，除外手术禁忌证，行右侧腹股沟区备皮。患者仰卧于DSA检查床，常规消毒铺巾，行右侧股动脉Seldinger穿刺，置鞘及导管，将导管尖端置于腹主动脉行盆腔血管造影，评估子宫及妊娠胚胎供血动脉情况，再将导管超选至双侧子宫动脉造影。A组取MTX常规剂量(2.5～3.0 mg/kg体质量)150～200 mg稀释至50 ml，B组MTX使用剂量(1.0 mg/kg体质量)40～60 mg，根据供血情况分配MTX稀释液用量，A组采用10 ml注射器经导管手动推注进行动脉灌注，B组将分配用量MTX稀释至100 ml，通过高压注射器以0.05 ml/s、150 PSI进行匀速动脉灌注，单侧子宫动脉灌注时间约33 min；……