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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2012, Vol. 08 ›› Issue (06) : 707 -710. doi: 10.3877/cma.j.issn.1673-5250.2012.06.008

所属专题： 文献；

论著

子宫动脉化疗栓塞术治疗完全性胎盘植入的临床疗效
张科荣1, 蒋静1, 夏智勇1, 陶建华2,*,*(), 缪南东3, 范波1, 陈小芬1, 敬巧1, 邓进3   
  1. 1. 637000　四川南充，川北医学院附属医院妇产科
    2. 川北医学院病原生物学中心
    3. 637000　四川南充，川北医学院附属医院介入科
  • 收稿日期:2012-05-10 修回日期:2012-10-30 出版日期:2012-12-01
  • 通信作者: 陶建华

Clinical Effects of Uterine Artery Chemoembolization in the Treatment of Complete Placental Implantation

Ke-rong ZHANG1, Jin JIANG1, Zhi-yong XIA1, Jian-hua TAO2(), Nan-dong MIAO3, Bo FAN1, Xiao-fen CHEN1, Qiao JIN1, Jing DEN3   

  1. 1. Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
  • Received:2012-05-10 Revised:2012-10-30 Published:2012-12-01
  • Corresponding author: Jian-hua TAO
  • About author:
    (Corresponding author: TAO Jian-hua, Email: )
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张科荣, 蒋静, 夏智勇, 陶建华, 缪南东, 范波, 陈小芬, 敬巧, 邓进. 子宫动脉化疗栓塞术治疗完全性胎盘植入的临床疗效[J/OL]. 中华妇幼临床医学杂志(电子版), 2012, 08(06): 707-710.

Ke-rong ZHANG, Jin JIANG, Zhi-yong XIA, Jian-hua TAO, Nan-dong MIAO, Bo FAN, Xiao-fen CHEN, Qiao JIN, Jing DEN. Clinical Effects of Uterine Artery Chemoembolization in the Treatment of Complete Placental Implantation[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2012, 08(06): 707-710.

目的

探讨子宫动脉化疗栓塞术治疗完全性胎盘植入的临床疗效。

方法

选择2005年1月至2011年12月从外院转诊至本院及于本院经阴道分娩与引产后诊断为完全性胎盘植入患者23例为研究对象。本组23例患者产后经彩色多普勒超声(23例)及磁共振成像(MRI)(13例)证实为完全性胎盘植入。采用Seldinger技术穿刺成功后，将导管分别选择至双侧子宫动脉，每侧各注入50 mg甲氨蝶呤(MTX)后，采用明胶海绵颗粒栓塞子宫动脉，并观察胎盘排出情况及其排出时间(本研究遵循的程序符合川北医院附属医院人体试验委员会制定的伦理学标准，得到该委员会批准，并征得受试对象的知情同意)。

结果

本组23例患者均栓塞成功，无一例发生严重并发症。19例(82.61%)介入治疗成功，保留子宫，4例(17.39%)因宫腔严重感染不能控制而转行子宫切除术。月经分别于术后(8～11)个月正常来潮。

结论

子宫动脉化疗栓塞治疗完全性胎盘植入为安全、有效、微创的治疗方法，值得临床进一步推广使用。

关键词: 子宫动脉, 化疗, 栓塞, 完全性胎盘植入
Objective

To explore the clinical effects of uterine artery chemoembolization in the treatment of complete placental implantation.

Methods

From January 2005 to December 2011, a total of 23 cases who were diagnosed as complete placental implantation were included into this study. Among them, 17 cases transferred from other hospitals, another 5 cases had the initial operation in our hospital. All of them had the evidence of complete placental implantation which was confirmed by color Doppler ultrasound, meanwhile, 13 cases had the evidence of magnetic resonance imaging (MRI). After successful puncture by Seldinger technique, the catheter were selected to the uterine artery, each side injected 50 mg methotrexate (MTX), gelatin sponge particles were used for uterine artery embolization. The successful rate of placenta discharge and the duration of placenta dischange were observed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Affiliated Hospital of North Sichuan Medical College. Informed consent was obtained from all participates.

Results

Twenty-three cases (100.00%) were successfully embolized. No serious complications were occured. Nineteen cases (82.61%) were preserved the uterus, another four patients (17.39%) with serious infection so that they had to turn to hysterectomy. Follow-up showed that menstruation become normal in 8-11 months after operation.

Conclusions

Uterine artery chemoembolization in the treatment of complete placental implantation is a safe, effective and minimally invasive method. It is worth of further clinical promotion.

Key words: uterine artery, chemotherapy, embolization, complete placental implantation
表1 6例患者于外院行宫腔操作的具体表现
Table 1 The situation of 6 cases with uterine cavity operation in other hospitals
患者 转入医院级别 有无宫腔操作钳夹 钳夹出胎盘量(g) 钳夹术中出血量(mL) 入院时Hb(g/L)
1 镇级 有 60 950 76
2 镇级 有 30 800 74
3 镇级 有 0 0 109
4 镇级 有 40 1700 63
5 镇级 有 0 0 110
6 镇级 有 40 700 94
表2 胎盘排出时间[h，n(%)]
Table 2 The duration of placental discharge [h，n(%)]
n 5～7 7～10 10～14 15～19 20～24 25～30
19 1(5.26) 3(15.80) 7(36.84) 5(26.32) 2(10.53) 1(5.26)
表3 4例胎盘排出失败患者具体表现
Table 3 The situation of 4 cases with failure of placental discharge
患者 胎儿娩出后 血红蛋白(g/L) 体温(℃) 白细胞计数(×109/L) 细菌培养(血) 细菌培养(宫腔)
阴道出血 宫腔操作
1 无 有 63 40.2 22.6 有 有
2 无 有 86 39.6 26.8 无 有
3 无 有 74 40.3 21.2 有 有
4 无 有 78 39.5 19.3 无 有
表4 治疗后月经恢复时间[个月，n(%)]
Table 4 The menstrual recovery time after surgery [months, n(%)]
n 8 9 10 11
13 6(41.15) 3(23.08) 3(23.08) 1(7.69)
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