CAJ | 학술논문

目的：探讨子宫动脉化疗栓塞术（ uterine artery chemotherapy embolization ，UACE）治疗剖宫产瘢痕部位妊娠（ cesare-an section scar pregnancy ，CSP）的临床疗效。方法：回顾性分析2008年9月～2012年2月安徽省立医院医院收治的17例行子宫动脉灌注化疗加栓塞术治疗子宫瘢痕处妊娠患者的临床资料。结果：17例患者中，7例因瘢痕妊娠贸然清宫术中发生大出血而采用急诊UACE，所有发生大出血患者于UACE术后均停止出血，其中1例在术后第4天妊娠组织自行脱落，复查彩超子宫下段异常回声团消失，彩色多普勒血流信号消失，未予吸宫出院；8例患者采用UACE术后3天在B超监测下行吸宫术，吸宫术中均未出现大出血，自行脱落组织及吸宫组织均送病理，病理可见大量坏死的绒毛组织；4例患者UACE术后配合米非司酮保守治疗3天，其中3例血清人绒毛膜促性腺激素β亚单位（β-HCG）下降明显，疤痕处包块缩小，未清宫出院，1例患者术后血β-HCG下降缓慢，且包块突向子宫浆膜层，UACE术后第7天行子宫疤痕部位局部切除术，术后恢复良好；另4例在吸宫术中已见绒毛组织的患者，UACE术后血β-HCG下降明显，疤痕处包块缩小，未再给予米非司酮及吸宫出院，术后恢复良好。所有患者1月后复查β-HCG均完全降至正常。结论：子宫动脉灌注化疗加栓塞术治疗CSP相对微创、有效，尤其适用于CSP患者大出血的紧急治疗。
목적：탐토자궁동맥화료전새술（ uterine artery chemotherapy embolization ，UACE）치료부궁산반흔부위임신（ cesare-an section scar pregnancy ，CSP）적림상료효。방법：회고성분석2008년9월～2012년2월안휘성립의원의원수치적17례행자궁동맥관주화료가전새술치료자궁반흔처임신환자적림상자료。결과：17례환자중，7례인반흔임신무연청궁술중발생대출혈이채용급진UACE，소유발생대출혈환자우UACE술후균정지출혈，기중1례재술후제4천임신조직자행탈락，복사채초자궁하단이상회성단소실，채색다보륵혈류신호소실，미여흡궁출원；8례환자채용UACE술후3천재B초감측하행흡궁술，흡궁술중균미출현대출혈，자행탈락조직급흡궁조직균송병리，병리가견대량배사적융모조직；4례환자UACE술후배합미비사동보수치료3천，기중3례혈청인융모막촉성선격소β아단위（β-HCG）하강명현，파흔처포괴축소，미청궁출원，1례환자술후혈β-HCG하강완만，차포괴돌향자궁장막층，UACE술후제7천행자궁파흔부위국부절제술，술후회복량호；령4례재흡궁술중이견융모조직적환자，UACE술후혈β-HCG하강명현，파흔처포괴축소，미재급여미비사동급흡궁출원，술후회복량호。소유환자1월후복사β-HCG균완전강지정상。결론：자궁동맥관주화료가전새술치료CSP상대미창、유효，우기괄용우CSP환자대출혈적긴급치료。
Objective:To investigate the clinical value of uterine artery chemotherapy embolization ( UACE) in treatment of cesarean section scar pregnancy .Methods:The clinical data of 17 CSP patients before and after bilateral UACE in Anhui Medical University from June 2008 to February 2012 were analyzed retrospectively .Results:Among 17 patients,massive hemorrhage occurred in 7 patients because of uterine curettage rashly , then emergent UACE was adopted , All the patients with massive hemorrhage stopped bleeding after UACE , The pregnancy tissue of 1 case fell off in the fourth day , the abnormal echo mass and blooding signals disappeared in color Doppler and the pa -tient was discharged without curettage;8 patients underwent uterine curettage after 3 days under type B ultrasound , massive hemorrhage didn't occur in the patients during uterine curettage , the necrotic villus was found in the tissue from curettage and autotomy by pathologic examination.4 patients received conservative treatment with mifepristone three days after UACE , 3 patients were discharged without curet-tage because of progressive decline β-HCG and decreasing masses in the scar , 1 patient had enlarged masses in the scar and dissatisfac-tory β-HCG level at 7 days after operation , local resection was performed , the healing condition was good .4 patients with massive hem-orrhage and villus found by naked eye during uterine curettage were discharged without mifepristone and curettage because of progressive decline β-HCG and decreasing masses in the scar .All the patients were reexamined after one month, and the levels ofβ -HCG of all the patients decreased to normal levels .Conclusion: UACE is a minimally invasive , effective method for treatment of CSP , especially UACE can be used for emergent treatment of massive hemorrhage of CSP patients during uterine curettage .