甲氨蝶呤辅助宫腔镜电切术治疗剖宫产疤痕妊娠的疗效分析

Efficacy of hysteroscopic surgery combined with MTX in the treatment of cesarean scar pregnancy

目的:探讨宫腔镜电切术联合甲氨蝶呤化疗治疗剖宫产切口疤痕妊娠的临床疗效,并观察和分析其预后。方法:2013年7月至2015年7月间收入本院由超声联合β-HCG诊断的剖宫产疤痕妊娠31例,根据治疗方式不同分为两组:观察组15例为甲氨蝶呤+宫腔镜电切术+球囊压迫综合治疗,对照组16例为直接宫腔镜电切+球囊压迫治疗,观察两组患者围手术期情况(两组病人术中平均出血量、手术时间)以及术后血清β-HCG恢复正常时间和月经恢复时间。结果:对照组术中平均出血量(60.7±29.2)m L、手术时间(42.2±6.8)h、血清β-HCG恢复正常时间(39.9±16.6)d以及月经恢复时间(50.4±17.1)d。观察组术中平均出血量(31.7±15.7)m L、手术时间(31.9±4.9)h、血清β-HCG恢复正常时间(26.9±7.8)d以及月经恢复时间(34.9±7.1)d,均优于对照组,差异具有统计学意义(P<0.05)。结论:甲氨蝶呤辅助宫腔镜电切术治疗剖宫产切口妊娠具有较好的临床疗效。手术时间较短,手术损伤和术后不良反应较少,能够缩短患者康复时间,预后良好。

Objectives： To explore the efficacy of hysteroscopic surgery combined with MTX in the treatment of cesarean scar pregnancy. Methods： The study included 31 women admitted in Renmin Hospital of Wuhan University who were diagnosed as CSP by ultrasound from July 1,2013 to July 1,2015. The 31 cases were divided into two groups,experimental group and control group. The experimental group was given hysteroscopic surgery combined with methotrexate（ MTX） chemotherapy and the control group was given hysteroscopic surgery. Foley tamponade were used in these cases. The blood volume during curettage,operative time and the time of postoperative serum β- HCG returned to normal and menstruation recovery were observed. Results： The bleeding volume during curettage,operative time and the time of postoperative serum β- HCG returned to normal and menstruation recovery of experimental group was（ 31. 7 ± 15. 7） ml,（ 31. 9 ± 4. 9） h,（ 26. 9 ± 7. 8） d,（ 34. 9 ± 7. 1） d. The bleeding volume during curettage,operative time and the time of postoperative serum β- HCG returned to normal and menstruation recovery of control group was（ 60. 7 ± 29. 2） ml,（ 42. 2 ± 6. 8） h,（ 39. 9 ± 16. 6） d,（ 50. 4 ±17. 1） d. All the results of experimental group were better than these in control group,with statistically significant difference（ P〈0. 05）. Conclusions： Hysteroscopic surgery combined with MTX chemotherapy was safe and effective for cesarean scar pregnancy,with the advantage of minimal invasion,shorter duration of the operation,less blood loss and short recovery time.