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目的：探讨子宫动脉化疗栓塞术治疗胎盘植入的临床疗效及预后。方法：以胎盘植入患者61 例为研究对象，按治疗方式不同分为保守治疗组31 例和化疗栓塞组30 例。保守治疗组仅单纯口服米非司酮治疗，而化疗栓塞组采用子宫动脉化疗栓塞术进行治疗。比较两组患者的临床疗效、手术时间、出血量、输血量、住院时间、胎盘排出和月经复潮时间，术后并发症的发生情况，并随访术后1 年患者的月经情况和妊娠情况。结果：经子宫动脉化疗栓塞术后29 例成功止血，有1 例未能止血而行子宫切除术。栓塞术后未出现器官局部缺血坏死、神经损伤等严重并发症，发热、下腹痛为常见并发症。而保守治疗组的31 例患者中，因治疗失败导致切除子宫的7 例，仅24例有效保留子宫，成功率仅77.4%，严重影响患者以后的生育能力。6 例发生宫腔感染，4 例发生宫腔粘连。子宫动脉化疗栓塞组茁-HCG 恢复正常时间、输血量、胎盘完全清除时间、月经异常的发生情况均优于保守治疗组，差异有统计学意义(P＜0.05)。对子宫动脉化疗栓塞术组患者进行为期1 年的随访，14 例患者在术后1个月后有胎盘组织自阴道排出，有 11例患者2 个月后发现胎盘残留，予以清宫术，除3 例失访病例，其余患者在随访时间内恢复正常月经，并有2 例再次妊娠者。结论：采用子宫动脉化疗栓塞术治疗胎盘植入，其术前准备时间和手术时间均短，出血控制迅速且并发症少，有助于保留患者的子宫，提高患者的生活质量。

英文摘要:

Objective:To explore the clinical effects and prognosis of uterine artery chemoembolization on placenta implantation.Methods:61 cases of patients with placenta implantation were selected and divided into the conservative treatment group (31 cases) and chemoembolization group (30 cases). Patients in the conservative treatment group were treated by mifepristone orally alone, while chemoembolization group was treated by uterine artery chemoembolization. The clinical effects, surgery time, amount of blood loss, blood transfusion, hospital stay, menses return time, incidence of postoperative complications and the state of menstruation and pregnancies in the first year after surgery were observed and compared between two groups.Results:By uterine artery chemoembolization, bleeding was successfully stopped in 29 cases of patients, one patient still bleeding was treated with resection. There was no serious complications (e.g. organ ischemia necrosis, nerve injury) after uterine artery chemoembolization but fever and hypogastralgia were the common complications. In the conservative treatment group, 7 cases were carried out hysterectomy due to treatment failure, only 24 cases effectively retained the womb, the successful rate was only 77.4%, this had a serious influence on patients after fertility. 6 cases were caused by intrauterine infection, 4 cases were caused by intrauterine adhesions. The chemoembolization group was significantly superior to the conservative treatment group in the 茁-HCG recovery time, blood transfusion, the completely clear time of placenta and irregular menstruation (P＜0.05). In one year's follow-up of patients with uterine artery chemoembolization, 14 patients' placenta tissue discharge in one month after surgery, 11 patients had placental retention two months later and carried out complete curettage of uterine cavity, the other patients were all menses returned and 2 cases were pregnancy again, except 3 patients lost in touch.Conclusion:Uterine artery chemoembolization had shorter prepared time before surgery and in surgery as well as bleeding time in the treatment of placenta implantation, which had few complications and could keep the patient's uterus, improve the quality of life.

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