米非司酮及米索前列醇联合宫腔镜切除内生型子宫下段剖宫产切口瘢痕处妊娠的疗效

Effect of Mifepristone and misoprostol combined with hysteroscopic resection of endometrial uterine incision cesarean scar pregnancy

目的探讨米非司酮及米索前列醇联合宫腔镜切除内生型子宫下段剖宫产切口瘢痕处妊娠的临床效果。方法应用回顾性研究方法对本院2015年1月至2017年10月收治的135例内生型子宫下段剖宫产切口瘢痕处妊娠患者的病例资料进行分析,根据治疗方式分为A组(米非司酮及米索前列醇联合宫腔镜)、B组(甲氨蝶呤全身用药+清宫术)、C组(子宫动脉栓塞术+清宫术)各45例,对比三种方法的治疗效果。结果手术前,A、B、C三组患者的孕囊大小、血清β-人绒毛膜促性腺激素(β-HCG)水平比较,差异均无统计学意义(P> 0. 05);手术后,A、C两组患者的手术时间、术中出血量、血清β-HCG降至正常时间、阴道出血时间、住院时间均显著低于B组(P <0. 05); A组和C组的手术时间、血清β-HCG降至正常时间、阴道出血时间、住院时间比较差异无统计学意义(P> 0. 05),A组的月经来潮时间显著短于B组和C组(P <0. 05); A、B、C三组的治疗有效率分别为100. 00%、97. 78%、100. 00%,三组间比较差异均无统计学意义(P> 0. 05); A、B、C三组的治疗并发症发生率分别为2. 22%、13. 33%、4. 44%,三组间比较差异均无统计学意义(P> 0. 05)。结论三种方法治疗内生型子宫下段剖宫产切口瘢痕处妊娠效果相当,米非司酮及米索前列醇联合宫腔镜具有手术创伤更小、术后恢复更快的特点。

Objective To investigate the clinical effect of mifepristone and misoprostol combined with hysteroscopic resection of endometrial uterine incision cesarean scar pregnancy.Methods A retrospective study was conducted to analyze 135 cases of scar pregnancy of endogenous lower uterine cesarean section from January 2015to October 2017.According to the treatment methods,they were divided into group A (mifepristone and misoprostol combined with hysteroscopy),group B (methotrexate combined with hysteroscopy),group C (Uterine artery embolization + curettage).Each group had 45 cases,and the therapeutic effects of the three methods were compared.Results There was no significant difference in gestational sac size and serum human chorionic gonadotropin [beta-human chorionic gonadotropin (HCG)]levels among the three groups before operation (P >0.05).After operation,the operation time,intraoperative bleeding volume,serum beta-HCG dropping to normal time,vaginal bleeding time and hospitalization time in A and C group were significantly lower than that in B group (P >0.05).There was no significant difference between group A and group C in operation time,serum beta-HCG to normal time,vaginal bleeding time and hospitalization time(P>0.05).The menstruation time of group A was signifieantly shorter than that of group B and group C (P <0.05).The effective rates of group A,B and C were 100.00%,97.78% and 100.00% respectively,with no significant difference in the three groups (P >0.05);The complication rates of A,B and C groups were 2.22%,13.33% and 4.44% respectively,with no significant difference in the three groups (P >0.05).Conclusions The three methods are effective in the treatment of cesarean scar pregnancy.The mifepristone and misoprostol combined with hysteroscopy have the advantages of less operative trauma and faster postoperative recovery.