Ectopic pregnancy is one of the common acute abdominal conditions in obstetrics and gynecology, which is life-threatening if it ruptures. Traditional treatment methods mostly use open tubectomy, which is unacceptable for women who want to have children. The Department of Obstetrics and Gynecology and our department have been working closely together on a new method to preserve the affected fallopian tube and have adopted a new way of minimally invasive interventional treatment for ectopic pregnancy, i.e. intravesical injection of the tubal embryo sac and intrauterine arterial cannulation of MTX to kill the chorionic trophoblast and cause abortion, necrosis and dissipation of the ectopic embryo sac.
These two minimally invasive interventions are simple, safe, and free of serious complications. They are effective and have a significantly shorter duration of treatment, and they can keep the fallopian tubes open after treatment and significantly increase the rate of recurrence of pregnancy without leaving any scars after surgery. Transvascular intervention can stop the bleeding immediately and can directly give pelvic anti-inflammatory drugs to achieve very effective and quick control of pelvic inflammatory disease.
Uterine fibroids, also known as uterine smooth muscle tumors, are the most common benign tumors of the female reproductive organs. They can cause increased menstrual flow with blood clots, prolonged menstrual cycles, vaginal bleeding, combined infections and ulcers, infertility, urinary frequency, urinary urgency, even urinary retention, anemia, lumbosacral pain, and in rare cases, malignancy.
The biggest advantages of interventional treatment are
1. It preserves the function of the uterus intact, does not affect normal menstruation, pregnancy and childbirth, and can return a complete woman to your family;
2, it avoids the traumatic blow and a series of post-operative complications of conventional obstetrical and gynecological surgery, and its effect on symptom improvement is comparable to that of surgery;
3.Small trauma, fast recovery, short hospitalization time makes it easy for patients to accept;
4, even if an intervention fails, it does not affect the surgery and medication in any way;
5, the method is also suitable for patients with adenomyosis.
I. Overview of uterine fibroids
Uterine fibroids, also known as uterine smooth muscle tumors, are the most common benign tumors in female reproductive organs, most often found in middle-aged women, with an incidence of about 20%.
Classification and growth pattern of uterine fibroids
Uterine fibroids grow out from the myometrium, and most of them occur in the myometrial wall at the beginning. According to the relationship between fibroids and the myometrial wall, they can be classified as: subplasmic fibroids, submucosal fibroids, and intermyometrial fibroids.
Treatment methods of uterine fibroids
1.Surgical treatment
2.Medication
3.Interventional treatment: minimally invasive treatment methods
Contraindications and indications for interventional treatment.
1.Indications.
① Females of childbearing age;
② uterine fibroids with clear diagnosis and obvious symptoms of excessive menstrual bleeding and occupational pressure caused by them;
③ Conservative treatment (including drug therapy and myomectomy) is ineffective or recurrent;
④ Those who refuse surgery and want to preserve the uterus and fertility;
⑤ Those who have special religious beliefs that prevent blood transfusion and surgery;
(6) Patients who agree to embolization and are willing to choose it;
⑦ Asymptomatic uterine fibroids with a diameter of ≥4 cm, but the patient has a heavy psychological burden and requests treatment;
(8) Weak or combined with serious medical diseases such as diabetes mellitus who cannot tolerate surgery.
2. Contraindications.
① including serious dysfunction of heart, liver, kidney and other important organs;
②Severe coagulation mechanism abnormalities;
(iii) Acute and chronic gynecological inflammation not controlled;
④Infection at the puncture site;
⑤ subplasmic fibroids with tissues, broad ligament fibroids.
(6) Uterine fibroids with rapid growth and suspected sarcoma.
V. Principle of interventional treatment
In other words, a certain size and amount of embolic particles are pushed into the uterine artery through the catheter to embolize the blood supplying artery of the fibroid, causing ischemic and anoxic necrosis of the fibroid, resulting in a significant reduction of the total number of fibroid cells and atrophy of the fibroid, thus relieving or eliminating a series of clinical symptoms associated with it.
Interventional treatment methods
The unilateral (right) femoral artery approach is mostly used, but sometimes the unilateral approach can only be used bilaterally if the patient has difficulty in intubation due to the special vascular route and anatomy. The catheter will be superselected into the bilateral uterine arteries, and the embolic agent will be injected to embolize the uterine arteries.
VII. Postoperative management
Routine postoperative treatment according to arterial embolization, and anti-inflammatory and symptomatic treatment should be given, and antibacterial rehydration should be strengthened.
VIII. Complications
(1) Local pain, increased skin temperature, redness and swelling, fever, which is the manifestation of post-embolization syndrome;
②Vaginal fluid discharge, which is mostly necrotic material of uterine fibroids;
③Serious rare complications include endometritis, uterine pus accumulation, uterine perforation, which are mostly related to intrauterine infection.
IX. Evaluation of therapeutic effect
1. Generally, after three months, the size of fibroids can be reduced significantly, ranging from 20-84%;
2.Menstruation is normalized and excessive menstrual bleeding is corrected;
3. From the present report, it seems to have no effect on conception and normal delivery.
Advantages of interventional treatment
1.The biggest advantage is that the uterine functions, such as normal menstruation, pregnancy and childbirth, can be preserved intact; it avoids the traumatic blow of surgery and a series of postoperative complications, and the effect on symptom improvement is comparable to that of surgery;
2. It is easy for patients to accept because of the small trauma, quick recovery and short hospitalization time; 3.
This method is also suitable for vascular intervention for ectopic pregnancy, which can not only preserve the uterus and fallopian tubes intact, but also improve the chances of re-pregnancy because of the high embryo killing rate, and has incomparable advantages for the control of pelvic inflammatory disease.