CAJ | 학술논문

目的探讨简捷、安全、保留器官完整性的微创手术治疗异位妊娠的方法.方法对56例异位妊娠患者行右侧股动脉穿刺插管,超选择插入至患侧子宫动脉,造影观察病变的范围、血供来源及有无活动性出血,然后将甲氨蝶呤150 mg粉剂稀释至100 ml经导管缓慢注入子宫动脉,再用05 mm×0.5 mm×0.5 mm的明胶海绵碎粒适量栓塞子宫动脉,至子宫动脉分支不显影为止,随访观察疗效.结果 56例均成功实施了超选择性子宫动脉灌注栓塞术,无相关并发症.33例腹腔活动性出血患者栓塞后出血立即停止.13例胚胎存活患者第2天超声复查存活胚胎全部死亡.56例患者血绒毛膜促性腺激素β亚单位均在术后3-12 d降至5 U/L以下,腹腔积血1周后全部吸收.1个月后混合性包块完全吸收消失.术后3个月行子宫输卵管造影19例,11例显示患侧输卵管通畅.结论超选择性子宫动脉灌注栓塞治疗异位妊娠,能有效杀灭胚胎组织、栓塞破裂血管,止血效果明显,手术创伤小,且能保留输卵管.
목적 탐토간첩、안전、보류기관완정성적미창수술치료이위임신적방법.방법 대56례이위임신환자행우측고동맥천자삽관,초선택삽입지환측자궁동맥,조영관찰병변적범위、혈공래원급유무활동성출혈,연후장갑안접령150 mg분제희석지100 ml경도관완만주입자궁동맥,재용05 mm×0.5 mm×0.5 mm적명효해면쇄립괄량전새자궁동맥,지자궁동맥분지불현영위지,수방관찰료효.결과 56례균성공실시료초선택성자궁동맥관주전새술,무상관병발증.33례복강활동성출혈환자전새후출혈립즉정지.13례배태존활환자제2천초성복사존활배태전부사망.56례환자혈융모막촉성선격소β아단위균재술후3-12 d강지5 U/L이하,복강적혈1주후전부흡수.1개월후혼합성포괴완전흡수소실.술후3개월행자궁수란관조영19례,11례현시환측수란관통창.결론 초선택성자궁동맥관주전새치료이위임신,능유효살멸배태조직、전새파렬혈관,지혈효과명현,수술창상소,차능보류수란관.
Objective To probe a simple, safe, and minimally invnsive method to treat ectopic pregnancy with preservation of the organs. Methods Superselective catheterization of uterine artery through cannulation of right femoral artery was achieved in 56 patients with ectopic pregnancy. Location of the lesions involved, feeding arteries, and active bleeding were observed on angiography. 150 mg of methylamine neopterin diluted in 100 ml of saline water was infused slowly into the target artery. Small gelatin spongy particles with size of 0.5 mm in diameter were used to embelize the uterine artery until its branches were totally obliterated. Follow-up was undertaken to observe the results of the treatment. Results Suporselective uterine arterial infusion and embolization were successfully performed in all 56 patients without any related complications. Active bleeding in the peritoneum in 33 cases ceased soon after embolization. The embryos in 13 patients were confirmed to have died by ultrasound two days after the procedure. Beta-HCG value dropped to below 5 U/L within two to twelve days. Hemorrhage in the peritoneum dissolved after seven days in all cases. Mixed mass disappeared after one month. Histerosalpingography was performed three months after the procedure in 19 patients and patent fallopians were demonstrated in 11 patients. Conclusions Superselective uterine arterial infusion and embolization is a minimally invasive procedure, which can be used to effectively treat ectopic pregnancy by disabling the ectopic embryo and embelizing leaking arteries with the advantages of preserving the fallopian tubes.