综述

子宫动脉栓塞后清除剖宫产瘢痕妊娠的方式与时机选择

  • 俞丽萍 ,
  • 薛卓维 ,
  • 滕银成
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  • 上海交通大学附属第六人民医院妇产科,上海 200233
俞丽萍(1994—),女,硕士生;电子信箱:yuliping_iris@163.com
滕银成,电子信箱:ycteng@sjtu.edu.cn

网络出版日期: 2021-10-22

基金资助

上海市卫生和计划生育委员会科研课题(201640373)

Methods and timing of removing cesarean scar pregnancy after uterine artery embolization

  • Li-ping YU ,
  • Zhuo-wei XUE ,
  • Yin-cheng TENG
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  • Department of Obstetrics and Gynecology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
TENG Yin-cheng, E-mail: ycteng@sjtu.edu.cn.

Online published: 2021-10-22

Supported by

Scientific Research Project of Shanghai Health and Family Planning Commission(201640373)

摘要

剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)是一种严重威胁育龄女性生命安全、导致其生育功能丧失的特殊类型异位妊娠。子宫动脉栓塞术(uterine artery embolization,UAE)是用于治疗CSP的辅助手段,其可迅速阻断病灶血供,减少出血量。临床上,常采用UAE的联合方案对CSP进行治疗,如联合药物治疗(甲氨蝶呤等)、手术治疗(清宫术,宫腔镜术,及经腹、腹腔镜、经阴道等途径)来清除妊娠物。目前,针对不同类型的CSP,如何选择UAE联合治疗方案及清除妊娠物的时机同时兼顾治愈率和安全性是临床医师面临的问题。且国内外对CSP的治疗方案尚无明确的指南和统一的标准。文章回顾了近年来国内外文献,对UAE联合不同治疗方式的效果及清除妊娠物的时机进行综述,以期为后续的研究提供参考。

本文引用格式

俞丽萍 , 薛卓维 , 滕银成 . 子宫动脉栓塞后清除剖宫产瘢痕妊娠的方式与时机选择[J]. 上海交通大学学报(医学版), 2021 , 41(11) : 1524 -1528 . DOI: 10.3969/j.issn.1674-8115.2021.11.019

Abstract

Cesarean scar pregnancy (CSP) is a special type of ectopic pregnancy that seriously threatens the life safety of women of childbearing age and leads to the loss of reproductive function. Uterine artery embolization (UAE) is an auxiliary method for the treatment of CSP, which can quickly block the blood supply to the lesion and reduce bleeding. Clinically, the combined scheme of UAE is often used to treat CSP, such as combined drug treatment (methotrexate, etc.), and surgical treatment (curettage, hysteroscopy, transabdominal, laparoscopic, transvaginal and other ways) to remove pregnancy. At present, for different types of CSP, how to choose the combination treatment scheme of UAE and the time to remove pregnancy while taking into account the cure rate and safety is a problem faced by clinicians. And there are no clear guidelines and unified standards for the treatment of CSP at home and abroad. This paper reviews the literature at home and abroad in recent years, and summarizes the effect of UAE combined with different treatment methods and the timing of removing pregnancy, in order to provide reference for follow-up research.

参考文献

1 金力, 陈蔚琳, 周应芳. 剖宫产术后子宫瘢痕妊娠诊治专家共识(2016)[J]. 中华妇产科杂志, 2016, 51(8): 568-572.
2 Timor-Tritsch IE, Monteagudo A, Calì G, et al. Cesarean scar pregnancy: patient counseling and management[J]. Obstet Gynecol Clin North Am, 2019, 46(4): 813-828.
3 Lin SY, Hsieh CJ, Tu YA, et al. New ultrasound grading system for cesarean scar pregnancy and its implications for management strategies: an observational cohort study[J]. PLoS One, 2018, 13(8): e0202020.
4 康彦君, 班艳丽, 张腾, 等. 子宫瘢痕妊娠实用临床分型及应用价值探讨[J]. 现代妇产科进展, 2019, 28(10): 731-735.
5 张伟, 王觅, 王莉杰, 等. 剖宫产后子宫瘢痕妊娠的DSA影像学研究[J]. 临床放射学杂志, 2020, 39(9): 1860-1864.
6 徐玉静, 付锦华, 褚玉静, 等. 剖宫产瘢痕妊娠数字化三维模型在其子宫动脉栓塞术中的应用[J]. 实用妇产科杂志, 2013, 29(4): 286-289.
7 Singhal S, Singh A, Raghunandan C, et al. Uterine artery embolization: exploring new dimensions in obstetric emergencies[J]. Oman Med J, 2014, 29(3): 217-219.
8 江苏省妇幼保健协会妇产介入分会, 江苏省医学会介入医学分会妇儿学组. 剖宫产瘢痕妊娠诊断与介入治疗江苏共识[J]. 介入放射学杂志, 2018, 27(10): 911-916.
9 Ma Y, Yang C, Shao XN. Efficacy comparison of transcatheter arterial embolization with gelatin sponge and polyvinyl alcohol particles for the management of cesarean scar pregnancy and follow-up study[J]. J Obstet Gynaecol Res, 2017, 43(4): 682-688.
10 刘津华, 张磊, 穆永旭. 明胶海绵颗粒和聚乙烯醇颗粒治疗瘢痕妊娠的临床效果比较[J]. 中华介入放射学电子杂志, 2018, 6(1): 51-54.
11 Spies J, Kohi M. Updates on uterine artery embolization[J]. Semin Intervent Radiol, 2018, 35(1): 48-55.
12 Liu Z, Wang Y, Yan J, et al. Uterine artery embolization versus hysterectomy in the treatment of refractory postpartum hemorrhage: a systematic review and meta-analysis[J]. J Matern Fetal Neonatal Med, 2020, 33(4): 693-705.
13 Qiu J, Fu Y, Huang X, et al. Acute pulmonary embolism in a patient with cesarean scar pregnancy after receiving uterine artery embolization: a case report[J]. Ther Clin Risk Manag, 2018, 14: 117-120.
14 Karlsen K, Hrobjartsson A, Korsholm M, et al. Fertility after uterine artery embolization of fibroids: a systematic review[J]. Arch Gynecol Obstet, 2018, 297(1): 13-25.
15 Kim YR, Moon MJ. Ultrasound-guided local injection of methotrexate and systemic intramuscular methotrexate in the treatment of cesarean scar pregnancy[J]. Obstet Gynecol Sci, 2018, 61(1): 147-153.
16 Fu LP. Therapeutic approach for the cesarean scar pregnancy[J]. Medicine (Baltimore), 2018, 97(18): e0476.
17 Elmokadem AH, Abdel-Wahab RM, El-Zayadi AA, et al. Uterine artery embolization and methotrexate infusion as sole management for caesarean scar and cervical ectopic pregnancies: a single-center experience and literature review[J]. Can Assoc Radiol J, 2019, 70(3): 307-316.
18 Gao J, Li X, Chen J, et al. Uterine artery embolization combined with local infusion of methotrexate and 5- fluorouracil in treating ectopic pregnancy: a CONSORT-compliant article[J]. Medicine (Baltimore), 2018, 97(5): e9722.
19 Glenn TL, Bembry J, Findley AD, et al. Cesarean scar ectopic pregnancy: current management strategies[J]. Obstet Gynecol Surv, 2018, 73(5): 293-302.
20 Miller R, Timor-Tritsch IE, Gyamfi-Bannerman C. Society for maternal-fetal medicine (SMFM) consult series #49: cesarean scar pregnancy[J]. Am J Obstet Gynecol, 2020, 222(5): B2-B14.
21 P?draszewski P, Wla?lak E, Panek W, et al. Cesarean scar pregnancy: a new challenge for obstetricians[J]. J Ultrason, 2018, 18(72): 56-62.
22 Qiu J, Fu YF, Xu JW, et al. Analysis on clinical effects of dilation and curettage guided by ultrasonography versus hysteroscopy after uterine artery embolization in the treatment of cesarean scar pregnancy[J]. Ther Clin Risk Manag, 2019, 15: 83-89.
23 Mahgoub S, Gabriele V, Faller E, et al. Cesarean scar ectopic pregnancy: laparoscopic resection and total scar dehiscence repair[J]. J Minim Invasive Gynecol, 2018, 25(2): 297-298.
24 Zhang XL, Pang YX, Ma YH, et al. A comparison between laparoscopy and hysteroscopy approach in treatment of cesarean scar pregnancy[J]. Medicine, 2020, 99(43): e22845.
25 OuYang Z, Xu Y, Li H, et al. Transvaginal hysterotomy: a novel approach for the treatment of cesarean scar pregnancy[J]. Taiwan J Obstet Gynecol, 2019, 58(4): 460-464.
26 胡桂, 罗丽娟, 刘菁. 子宫瘢痕妊娠患者子宫动脉化疗栓塞术后不同时机行清宫术治疗效果分析[J]. 中国计划生育和妇产科, 2019, 11(1): 63-65, 76.
27 Gao L, Huang Z, Gao J, et al. Uterine artery embolization followed by dilation and curettage within 24 hours compared with systemic methotrexate for cesarean scar pregnancy[J]. Int J Gynaecol Obstet, 2014, 127(2): 147-151.
28 Tumenjargal A, Tokue H, Kishi H, et al. Uterine artery embolization combined with dilation and curettage for the treatment of cesarean scar pregnancy: efficacy and future fertility[J]. Cardiovasc Intervent Radiol, 2018, 41(8): 1165-1173.
29 Qi F, Chai ZY, Liu MM, et al. Type 2 cesarean scar pregnancy successfully treated via hysteroscopy-assisted laparoscopy[J]. J Minim Invasive Gynecol, 2019, 26(7): 1273-1281.
30 徐郑军, 孙云, 侯标. 不同治疗手段对剖宫产术后子宫瘢痕部位妊娠的临床价值分析[J]. 中国妇产科临床杂志, 2021, 22(1): 82-83.
31 Liu G, Wu J, Cao J, et al. Comparison of three treatment strategies for cesarean scar pregnancy[J]. Arch Gynecol Obstet, 2017, 296(2): 383-389.
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