甲氨蝶呤、米非司酮联合宫腔镜电切术在剖宫产术后子宫瘢痕妊娠治疗中的应用

The application of Methotrexate,Mifepristone and Hysteroscopic surgery in treatment of Uterine scar pregnancy after cesarean scar

目的:探讨甲氨蝶呤(MTX)、米非司酮联合宫腔镜电切术在剖宫产术后子宫瘢痕妊娠(CSP)治疗中的应用价值。方法:回顾性分析收治的18例阴道彩超确诊早期CSP,按治疗手段的不同分两组。第Ⅰ组采用MTX囊内注射、静脉滴注配伍米非司酮口服12例,1周后行B超监测下清宫术,第Ⅱ组采用甲氨蝶呤囊内注射、静脉滴注配伍米非司酮口服治疗,1周后在B超下行宫腔镜电切术+清宫术6例,根据治疗后阴道流血量、血β-HCG、阴道彩超及住院时间比较两组的疗效。结果:治疗后1周阴道流血量、血β-HCG均明显下降,Ⅱ组血β-HCG下降百分比较Ⅰ组明显,Ⅱ组住院天数较Ⅰ组短,无一例并发症出现。结论:MTX、米非司酮联合宫腔镜电切术治疗剖宫产术后瘢痕妊娠较单一使用药物治疗更有效。

Objective： To explore the value of methotrexate, mifepriston and hysteroscopy in treatment for cesarean scar pregnancy. Methods： Retrospective analyzed of 18 cases diagnosed by transvaginal color ultrasound of early CSP, and were divided into two groups according to the different treatment. The group I 12 cases were given intracystieed, intravenous infusion MTX and eat mifepriston, curettaging under ultrasound monitoring after a week. Group Ⅱ 6 cases were intracysticed, intravenous infusion MTX and eat mifepriston, hysteroscopieing and eurettaging under ultrasound monitoring after a week, the amount of vaginal bleeding, serum [5-HCG, vaginal ultrasound and hospital stay were compared for efficacy. Resuits： The amount of vaginal bleeding, serum β-HCG were significantly decreased after one week treatment, the percentage of serum β-HCG of group Ⅱ dropped significantly compared with group I , group Ⅱ hospital days was shorter than that of group I , and none of the complications. Conclusion： MTX, mifepristone and hysteroscopy is more effective than single use of medication to cure resection of cesarean scar pregnancy.