甲氨蝶呤及生化汤联合治疗植入性胎盘的临床应用研究

Clinical application of methotrexate connecting biochemistry soup in placenta implantation

目的：探讨甲氨蝶呤（MTX）肌肉注射及中药生化汤联合治疗植入性胎盘的疗效。方法：将41例胎盘植入的患者随机分为两组，研究组19例，给予MTX治疗，方法为50rag隔日肌内注射3次，并于注射MTX后12—24h内加用甲酰四氢叶酸（CF）解毒，同时每天给予中药生化汤（加减）口服；对照组22例，仅采用口服中药生化汤（加减）治疗，两组治疗前血清β—HCG值、宫腔内病灶面积大小均无明显差异，两组均定期复查B超和血清β—HCG水平直至正常。结果：经治疗1周及2周后复查，研究组血清β—HCG值均较前次检查结果明显下降（P〈0．001），官腔内残留胎盘组织面积也较前次检查结果明显缩小（P〈0．001），与同期对照组血清β-HCG值及宫腔内残留庭盘组织面积相比较，其差异亦有统计学意义（P〈0．001），而研究组血清β—HCG水平降至正常时间亦较对照组明显缩短（P〈0．001）。结论：MTX肌内注射联合中药生化汤治疗胎盘植入，其效果较单纯应用中药生化汤治疗疗效更佳，可以有效治疗植入性胎盘，最大限度地保留子宫，保留生育功能。

Objective To study the effects of methotrexate connecting biochemistry soup for placenta implantation. Method Total 41 patients with placenta implantation were randomly divided into the research group（ n = 19） and the control group （n = 22）. Subjects of the research group were injected with 50 mg methotrexate （MTX） into muscle every other day. Leucovorin injection was used to prevent harmful effects of MTX in 12 - 24 hours after MTX injection, and biochemistry soup was taken orally every day. Control subjects were just treated with biochemistry soup. No differences of serum β - HCG level and area of residues of placenta were found between the two groups before treatment. Results After one or two weeks＇ treatment,serum β - HCG level decreased and was lower in the research group than the control group（P 〈 0. 001 ）. Area of residues of placenta significantly decreased in the research group than the control group （ P 〈 O. 001 ）. Meanwhile,the time of serum β - HCG level decreased to normal level was significantly shorter in the research group than the control group（ P 〈0. 001 ）. Conclusion MTX injection into muscle connecting biochemistry soup in placenta implantation can retain the uterus to the great extent, also the fertile ability.