中西医结合治疗中期引产胎盘植入临床分析

Clinical Analysis on Integrative Medicine for Placenta Accreta after Terminating the Mid-term Gestation

目的:探讨中期引产后保守治疗胎盘植入的方法。方法:将80例中期引产后胎盘植入的患者分为2组,对照组36例单次肌肉注射甲氨蝶呤加米非司酮,治疗组44例在对照组治疗的基础上口服协定"胎盘植入"中药处方治疗。2组均于治疗前、治疗后1、2、3周检测血清中β-HCG水平,并同期采用B超测量胎盘范围以评价治疗效果。结果:治疗组总有效率为93.18%,41例患者免行清宫术及宫腔镜下切除术;对照组总有效率为33.33%,实施清宫术者20例,行宫腔镜下切除者3例、子宫全切者1例,2组相比差异有统计学意义;治疗1周及2周后2组血清β-HCG值均较前次检查结果明显下降(P<0.01),超声提示宫腔内残留胎盘组织面积也较前次检查结果明显缩小(P<0.01),2组血清β-HCG值及宫腔残留面积比较,差异有统计学意义(P<0.01)。结论:单次肌肉注射甲氨蝶呤加米非司酮联合"胎盘植入"协定中药处方治疗胎盘植入疗效好。

Objective： To find the conservative method of treating placenta accreta after terminating the mid-term gestation.Method： Eighty patients were allocated into 36 cases in the control group and 44 cases in the treatment group.The control group received single intramuscular injection of methotrexate and mifepristone,the treatment group took the prescriptions against placenta accreta,the level of β-HCG in the serum was detected before treating and at the 1st,2nd and 3rd week after treating,meanwhile placental range was measured with type-B ultrasonic to assess curative effects.Result： Total effective rate of the treatment group was 93.18%,there were 41 patients without complete curettage of uterine cavity and hysteroscopic resection;total effective rate of the control group was 33.33%,20 patients were performed complete curettage of uterine cavity,three cases with hysteroscopic resection,one case with complete resection of the uterine,the difference had statistical meaning between both groups;serum β-HCG was decreased significantly in one week and two weeks after treating compared with the former examination（P〈0.01）,the results of B ultrasonic revealed that the area of residual placental tissue was shrinking than the former examination（P〈0.01）,the difference had statistical meaning in the comparison of β-HCG and residual areas of uterine cavity（P〈0.01）.Conclusion： Single intramuscular injection of methotrexate and mifepristone combined with the prescriptions are effective for placenta accrete.