Anlysis of the Bilateral Uterine Artery Embolization Combined With Methotrexate in Large Dose for Treatment of 56 Cases With Postpartum Hemorrhge of Placenta Accrete

doi:10.3877/cma.j.issn.1673-5250.2013.04.021

Objective

To explore the efficacy and feasibility of uterine arterial infusion and embolization(UAE) via bilateral uterine arteries for treatment of postpartum hemorrhage(PPH) of placenta implants by methotrexate(MTX) in large dose.

Methods

From April 2003 to July 2012, using Seldinger technique, 56 patients were treated for PPH via UAE by MTX in large dose individually. Among them, 9 cases were complete placenta implants and 47 cases were partial placenta implants. Informed consent was obtained from all participants.

Results

The average operating time was (40±5) min in total cases. After UAE, the average hemostatic time was (10.0±4.2) min. Each patient was rescued and retained the uterus. In the following up of 6 months, there was no evident complications among all cases.

Conclusions

UAE via bilateral uterine arteries for the treatment of PPH of placenta implants by MTX in large dose features fast, microinvasive, economic, retaining the uterus and fertility.

Key words: methotrexate, placenta accrete, uterine artery, uterine arterial embolization

图1 UAE前MIR(增强)见宫底胎盘植入

Figure 1 Placenta accrete in fundus of uterus on contrast enhancement MIRpre-UAE

图2 UAE前MIR T2WI压脂横断面见宫底胎盘植入

Figure 2 Placenta accrete in fundus of uterus on MIR T2WI pre-UAE

图3 UAE前MIRT2WI压脂矢状面见宫底胎盘植入

Figure 3 Placenta accrete in fundus of uterus on MR T2WI pre-UAE

图4 UAE前DSA造影见宫底部造影剂散在斑片状染色(A，B)

Figure 4 Placenta accrete in fundus of uterus on DSA radiography pre-UAE

图5 采用大剂量MTX进行UAE后第7天MIRT2WI矢状面见胎盘与宫壁出现间隙

Figure 5 Space appeared between placeta and uterine wall on MIR T2WI in 7 th d after UAE

表1 成功清除宫内胎盘组织与清除宫内胎盘组织失败患者不同时间段β-hCG水平比较(±s，mIU/mL)

Table 1 Comparison of the levels of β-hCG at different period of time between successful curettage and the failure curettage(±s，mIU/mL)

清宫术结果	n	3 d	(8～12) d	14 d	28 d	(55～60) d
成功	49	2740.0±30.5	730.0±30.5	130.0±30.5	0.8±0.4	－
失败	7	4560.0±30.5	1120.0±30.5	330.0±30.5	120.0±30.5	0.9±0.4

表1 成功清除宫内胎盘组织与清除宫内胎盘组织失败患者不同时间段β-hCG水平比较(±s，mIU/mL)

Table 1 Comparison of the levels of β-hCG at different period of time between successful curettage and the failure curettage(±s，mIU/mL)

清宫术结果	n	3 d	(8～12) d	14 d	28 d	(55～60) d
成功	49	2740.0±30.5	730.0±30.5	130.0±30.5	0.8±0.4	－
失败	7	4560.0±30.5	1120.0±30.5	330.0±30.5	120.0±30.5	0.9±0.4

表2 56例患者采用大剂量MTX进行UAE后相关并发症发生率比较[n(%)]

Table 2 Comparison of rate of complication after treatment by UAE among 56 patients [n(%)]

并发症	n	疼痛	发热	胃肠道反应	白细胞降低
阳性率	56	56(100.0)	22(39.2)	31(55.3)	9(16.0)

表2 56例患者采用大剂量MTX进行UAE后相关并发症发生率比较[n(%)]

Table 2 Comparison of rate of complication after treatment by UAE among 56 patients [n(%)]

并发症	n	疼痛	发热	胃肠道反应	白细胞降低
阳性率	56	56(100.0)	22(39.2)	31(55.3)	9(16.0)

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