甲氨蝶呤联合手术治疗子宫瘢痕处妊娠临床分析

Clinical analysis of methotrexate combined with surgery treating the uterine scar pregnancy

目的探讨甲氨蝶呤联合清宫术治疗子宫瘢痕处妊娠的效果。方法采用前瞻性对照研究,选取2011年2月～2013年2月在本院治疗的子宫瘢痕处妊娠患者54例,根据治疗方法分为两组,每组各27例,观察组采用甲氨蝶呤妊娠囊内注射联合清宫术治疗子宫瘢痕处妊娠,对照组采用甲氨蝶呤肌内注射治疗。两组患者每隔3d进行监测血β-HCG,观察血β-HCG降到正常值的时间、术中出血量、住院时间、治疗费用。结果观察组与对照组血β-HCG降到正常值的时间分别为(12.00±2.01)、(27.80±5.20)d,术中出血量分别为(45.00±5.65)、(123.76±15.68)ml,住院时间分别为(18.56±3.21)、(25.86±2.35)d,治疗费用分别为(1567.25±156.67)、(2467.88±115.66)元,差异有统计学意义(P<0.05)。结论甲氨蝶呤妊娠囊内注射联合清宫术治疗子宫瘢痕处妊娠,具有血β-HCG降到正常值的时间短、清宫术中出血量少、住院时间短、治疗费用低等优点,值得临床推广应用。

Objective To discuss the effects of methotrexate combined with the curettage treating the uterine scar pregnancy. Methods Prospective study was used.54 cases of patients with uterine scar pregnancy treated in our hospital from February 2011 to February 2013 were selected.According to the different treatment methods, patients were divided into two groups,each group had 27 cases.Treatments of gestational sac injection of methotrexate combined with the curettage for patients with uterine scar pregnancy were given in the observation group,while the intramuscular injection of methotrexate was used in the control group.The blood β-HCG level was monitored every 3 days and the time of β-HCG dropping to the normal,amount of intraoperative bleeding,hospital stays and cost of treatment were observed. Results The time of β-HCG dropping to the normal was （12.00±2.0） days and （27.80±5.20） days,amount of intraoperative bleeding was （45.00±5.65） ml and （123.76±15.68） ml, hospital stays was （18.56±3.21） days and （25.86±2.35） days, the cost of treatment was （1567.25 ±156.67） yuan and （2467.88 ±115.66） yuan respectively between the observation group and the control group,the differences were statistically significant （ P 0.05）. Conclusion Applying the gestational sac injection of methotrexate combined with the curettage to treat the uterine scar pregnancy has advantages of shorter time of β-HCG dropping to the normal,less amount of intraoperative bleeding,shorter hospital stays and lower cost of treatment.It is worthy of clinical application.