目的 研究宫腔镜下清宫术联合子宫动脉甲氨蝶呤(MTX)灌注及栓塞治疗胎盘植入的疗效.方法 选取泸州市中医医院妇产科2014年1月至2016年10月30日30例胎盘植入患者,通过5F子宫动脉导管对双侧子宫动脉实施选择性插管,MTX缓慢灌注后用明胶海绵颗粒栓塞患者双侧子宫动脉,术后1～2周对胎盘无法自行排出的患者实施宫腔镜下清宫术.结果 所有患者均顺利进行子宫动脉MTX灌注和栓塞术,19例大出血患者中12例术后出血立即停止,而7倒术后1.0～4.5h出血逐渐停止,13例患者胎盘在1周内经阴道自行排出,17例胎盘未自行排出患者在术后1～2周于宫腔镜下进行清宫术,均一次性清除植入的胎盘组织;术后2～6周血β-人绒毛膜促性腺激素恢复到正常水平.所有患者均未见子宫穿孔、畀位栓塞、宫腔内感染和粘连等术后并发症.结论 宫腔镜下行清宫术联合子宫动脉MTX灌注及栓塞对治疗胎盘植入的临床疗效较为理想,安全、可靠,值得临床上应用和推广.%Objective To study the curative effect of curettage under hysteroscope combined with methotrexate (MTX) infusion and embolization via uterine artery in treatment of placenta accreta.Methods Totally 30 cases with placenta accreta were selected during January 2014 to October 30th in 2016 in department of obstetrics and gynecology in Luzhou Hospital of Traditional Chinese Medicine.Bilateral uterine arteries selective catheterization through 5 F catheters were performed in all patients,which were followed by slow infusion of MTX and subsequent bilateral uterine artery embolization with gelatin sponge particles.Hysteroscopy curettage was undergone in patients who could not spontaneously discharge the placenta within 1 to 2 weeks after surgery.Results MTx infusion and embolization via uterine artery was obtained in all patients successfully.In 19 cases presenting massive hemorrhage,bleeding in 12 cases was stopped immediately after surgery,and bleeding in 7 cases was stopped gradually in 1.0 to 4.5 hours.The placentas were spontaneously discharged through vagina in 13 cases within l week,while 17 cases who didn't discharge the placentas spontaneously had to receive hysteroscopic curettage in 1-2 weeks after surgery.The placenta accreta tissues in all of the 30 cases were completely eliminated by single procedure.The blood β-human chorionic gonadotropin level dropped to normal range in 2-6 weeks after surgery.Uterine perforation,ectopic embolism,intrauterine infection and adhesions as well as other postoperative complications were not observed in all patients.Conclusion The curative effect of curettage under hysteroscope combined with methotrexate (MTX) infusion and embolization via uterine artery in treatment of placenta accreta is effective,safe and reliable.So it deserves to be promoted and applied in clinical work.
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