经阴道孕囊腔内注射氨甲喋呤辅以清宫术治疗剖宫产后切口妊娠的临床价值

Clinical Value of Transvaginal Gestational Sac Injection of Methotrexate Assisted with Uterine Curettage for the Treatment of Cesarean Scar Pregnancy

【目的】探讨B超监测下双腔拾卵针经阴道孕囊腔内注射氨甲喋呤（MTX）＋清宫术治疗剖宫产术后切口妊娠（CSP）的临床价值。【方法】选取本院2005年1月至2010年6月收治的切口妊娠患者63例：14例予以MTX＋清宫术（A组），22例予以MTX＋宫腔镜术（B组），27例行B超监测下双腔拾卵针经阴道孕囊腔内注射MTX＋清宫术（c组），比较三组的治疗成功率和并发症的发生率。【结果】C组的有效率、治疗天数、清宫时间及治疗费用均显著优于A组和B组（P〈0．05）；C组出血量、宫腔填塞、子宫穿孔、MTX毒副反应发生率显著低于A组和B组（P〈0．05）；三组间宫腔血肿和子宫锲形切除修补术比较无显著性差异（P〉0．05）。【结论】B超监测下双腔拾卵针经阴道孕囊腔内注射MTX＋清宫术治疗CSP成功率高，手术耗时少、母体损伤小，住院时间短和费用低等优点，是一种安全，有效的治疗方法，值得推广。

[Objective]To explore the clinical value of transvaginal gestational sac injection of methotrexate（MTX） by double lumen needle plus uterine curettage monitored by B-ultrasound for the treatment of cesarean scar pregnancy（CSP）. [Methods] Sixty three CSP patients treated in our hospital from Jan. 2005 to June 2010 were chosen. Fourteen cases （group A） were given MTX plus uterine curettage. Twenty two cases（group B） were given MTX plus hysteroscopy. Twenty seven cases（group C） received transvaginal gestational sac injection of MTX by double lumen needle plus uterine curettage monitored by B-ultrasound. The successful rate of treatment and the incidence of the complications were compared among 3 groups. [Results] There were significant differences in the effective rate, treatment duration, the time of uterine curettage and the incidence of adverse reactions of MTX between group A and group B（ P〈0.05）. There were also significant differences in blood loss, bleeding volume, intrauterine obturation, uterine perforation and the incidence of adverse reactions of MTX（92.6% ） between group C and group A and B（ P〈0.05）. There was no significant difference in intrauterine hematoma and uterus wedge resection among 3 groups（ P〉0; 05）. [Conclusion] Transvaginal gestational sac injection of methotrexate（MTX） by double lumen needle plus uterine curettage monitored by B-ultrasound for the treatment of CSP has advantages such as high successful rate, less operation time, minimal maternal injury, short hospital day and low cost, etc. Therefore it is a safe and effective therapy method and worthy of being extended.