经阴道彩色多普勒超声对不同剂量甲氨蝶呤治疗瘢痕妊娠疗效的评价

Application of transvaginal color Doppler ultrasound in evaluating clinical efficacy of different doses of MTX applied to cesarean scar pregnancies

目的利用经阴道彩色多普勒超声评价不同剂量甲氨蝶呤（MTX）经子宫动脉输液治疗剖宫产瘢痕妊娠的疗效。方法 48例剖宫产瘢痕妊娠患者,按MTX治疗剂量不同分60 mg、100 mg、150 mg和200 mg共4组,随访并分析各组治疗前后的灰阶超声声像图、胚囊周围的血流信号及胚囊周边肌层的血流阻力指数（RI）变化。结果 48例患者的经阴道彩色多普勒超声检查初诊符合率为100.0%,均表现为胚囊型;各组患者经MTX化疗后,灰阶声像图表现（孕囊大小、子宫切口瘢痕厚度）均较化疗前有明显改变;胚囊周围肌层血流RI值均增高,t=16.72～21.81,t_（0.01）=2.819,t〉t_（0.01）（P〈0.01）;60 mg组与2 00 mg组化疗前后超声表现的差异有统计学意义,χ~2=4.8～5.4,χ~2_（0.05）=3.84,χ~2〉χ~2_（0.05）（P〈0.05）。结论经阴道彩色多普勒超声可为不同剂量MTX经子宫动脉输液术的疗效评估提供可靠的依据。

Objective To evaluate the therapeutic effect of different doses of methotrexate（MTX） applied in uterine artery embolization for patients with cesarean scar pregnancy（CSP） with transvaginal color Doppler ultrasound.Methods 48 cases of CSP were devided into four groups according to the dosage of MTX,which was at 60 mg,100 mg,150 mg and 200 mg,respectively. The sonographic characteristics,the blood flow around the embryo and the blood flow resistance index（RI） of the myometrium around embryo were followed up in all cases,and analyzed.Results The accuracy of preliminary diagnosis coincidence was 100%.The changes of gray-scale sonography after MTX treatment were obvious in each group,including the the embryo size and the thickness of the uterine cesarean scar.RI of the myometrium around embryo in each group was significandy increased after MTX treatment,r=16.72-21.81,t0.01=2.819,t〉t0.01（P〈0.01 ）.After MTX treatment,sonographic characteristics changed in each group. However,the statistical differences were only shown between the 60 mg group and the 200 mg group,χ2 =4.8-5.4,χ20.01=3-84,χ2〉χ20.05（P〈0.05）.Conclusion Transvaginal color Doppler ultrasound plays an important role in evaluation therapeutic effect of different doses of MTX applied in uterine artery embolization.