章晓乐，何培芝，胡春花，钱麟，王蓉，姚淑芬，王萍*

(1.上海中医药大学附属曙光医院妇科，上海　201203；2.上海闸北区中心医院，上海　200070)



子宫动脉栓塞化疗后内视镜下孕囊定位吸引术治疗剖宫产切口妊娠临床研究

章晓乐1#，何培芝1#，胡春花1，钱麟1，王蓉1，姚淑芬2，王萍1*

(1.上海中医药大学附属曙光医院妇科，上海201203；2.上海闸北区中心医院，上海200070)

目的探讨子宫动脉栓塞(UAE)化疗后内视镜下孕囊定位吸引术治疗剖宫产切口妊娠的临床效果，及UAE化疗无效的处理方案。方法回顾性分析2013年6月至2015年8月23例因剖宫产子宫切口妊娠(CSP)行双侧UAE及氨甲喋呤(MTX)介入化疗联合内视镜下孕囊定位吸引术治疗的临床效果，及UAE失败补救性处理——B超引导下孕囊穿刺注射MTX杀胚后内视镜下孕囊定位吸引术治疗效果。结果23例UAE患者均行内视镜下孕囊定位吸引术，无一例子宫穿孔、大出血等严重并发症发生。其中5例术前孕囊内见心管搏动者，行UAE 48 h复查B超，仅1例未见胎心消失。2例UAE后48 h HCG下降不明显，继续B超引导下孕囊穿刺注射MTX杀胚后，再行内窥镜下负压吸宫术终止妊娠，均治疗成功。结论UAE化疗治疗后内视镜下孕囊定位吸引术定位准确，治疗CSP可靠、有效。对于UAE化疗治疗失败的CSP患者，在B超引导下孕囊穿刺注射MTX杀胚后，再进行内视镜下孕囊定位吸引仍然有效，但仍有必要进一步研究。

子宫疤痕妊娠；子宫动脉栓塞；内视镜

Methods：The data of 23 patients with CSP who underwent gestational sac aspiration guided by uterus endoscope after bilateral UAE combined with chemotherapy from Jun 2013 to Aug 2015 were retrospectively analyzed to evaluate the clinical effect. It is also evaluated the effect of remedial treatment after the failure of UAE，that is，the gestational sac puncture and injection of MTX to kill the embryo guided by B-ultrasound，then application of gestational sac aspiration guided by uterus endoscope.

Results：Twenty three patients with UAE were all performed gestational sac aspiration guided by endoscope，and there were no serious complications such as uterine perforation，bleeding，etc. Among them，5 patients appeared heart tube pulse in gestational sac before operation were rechecked by B-ultrasound，and only one patient still had heart tube pulse. Two patients whose HCG levels were not declined 48 hours after UAE underwent the gestational sac puncture and injection of MTX to kill the embryo guided by B-ultrasound，and then，treated with gestational sac aspiration guided by endoscope. All the treatment were successful.

Conclusions：Gestational sac aspiration guided by endoscope after UAE combined with chemotherapy is reliable and effective to treat CSP. If the patients fail the treatment of UAE combined with chemotherapy，they can still be treated by gestational sac aspiration guided by endoscope. However，it needs further investigation.

(JReprodMed2016，25(10)：943-946)

剖宫产术后子宫瘢痕妊娠(CSP)是指孕卵种植于前次剖宫产后子宫瘢痕处的妊娠，是一种特殊的异位妊娠。……