宫腔镜手术联合甲氨蝶呤治疗剖宫产术后子宫瘢痕妊娠的临床疗效和安全性分析

Clinical efficacy and safety of hysteroscopy surgery combined with methotrexate for treating the patients with cesarean scar pregnancy

目的探讨宫腔镜手术联合甲氨蝶呤治疗剖宫产术后子宫瘢痕妊娠（CSP）的临床疗效和安全性。方法回顾性分析64例CSP患者的临床资料，64例患者根据治疗方法不同分为观察组（46例）和对照组（18例），对照组采用局部妊娠囊内注射甲氨蝶呤后联合清宫术治疗，观察组采用局部妊娠囊内注射甲氨蝶呤后联合宫腔镜下病灶电切术治疗。观察两组患者术中出血量、血清8．人绒毛膜促性腺激素（hCC）降至正常所需时间、住院时间及临床疗效，出院后随访6个月观察月经恢复情况。结果观察组总有效率为100．0％（46／46），对照组总有效率为66．7％（12／18），两组比较差异有统计学意义（x2=16．920，P〈0．01）。观察组术中出血量、血清p．hCG降至正常所需时间和住院时间均显著低于对照组[（35．46±11．63）ml比（176．78±57．96）ml、（21．04±6．79）d比（39．65±12．79）d、（13．89±4．63）d比（26．82±8．94）d，P〈0．01]。观察组手术一次成功，无并发症发生；对照组在清宫术中有4例出现大出血，2例因清宫不完全行开腹病灶切除术，随后被迫行子宫切除术。观察组30-39d月经来潮率明显高于对照组[84．8％（39/46）比25．0％（4／16），P〈0．01]。结论宫腔镜手术联合甲氨蝶呤治疗CSP临床效果确切，且安全可靠，值得临床推广。

Objective To investigate the clinical efficacy and safety of hysteroscopy surgery combined with methotrexate （MTX） for treating the patients with cesarean scar pregnancy （CSP）. Methods The clinical data of 64 patients with CSP were retrospectively analyzed. The patients were divided into observation group （46 cases ） and control group （ 18 cases） according to treatment methods, the control group was given the therapy of local pregnancy intracapsular MTX combined with uterine curettage,and the observation group was given the therapy of local pregnancy intracapsular MTX combined with lesions removed surgery by hysteroscopy. The intraoperative blood loss, epistrophy time of β -human chorionic gonadotrophin （hCG）,hospitalization time,clinical efficacy of the two groups were observed. Follow-up for 6 months the menstruation of the two groups was observed. Results The total effective rate in observation group was significantly higher than that in control group [ 100.0%（46/46） vs. 66.7%（12/18）, X2 = 16.920,P 〈 0.01 ]. The intraoperative blood loss,epistrophy time of β-hCG and hospitalization time in observation group were significantly lower than those in control group [ （35.46 ± 11.63 ） ml vs. （ 176.78 ± 57.96） ml, （21.04 ±6.79 ） d vs. （39.65 ± 12.79） d, （ 13.89 ± 4.63） d vs. （26.82 ± 8.94） d,P 〈 0.01 ]. The observation group had a successful surgery and no complications. In the control group,4 cases occurred uterine curettage intraoperative bleeding,2 cases underwent open lesion resection and then were forced to line hysterectomy. The rate of menstruation in observation group after operation 30 - 39 d was significantly higher than that in control group [84.8%（39/46） vs. 25.0%（4/16）,P〈 0.01 ]. Conehmions Hysteroscopy surgery combined with MTX for treating the patients with CSP has exact clinical effect. It is safe and reliable, and is worthy of promotion and aoolication.