甲氨蝶呤联合米非司酮治疗与介入治疗在剖宫产术后瘢痕妊娠中的疗效比较

COMPARISON OF EFFICACY OF METHOTREXATE COMBINED WITH MIFEPRISTONE AND INTERVENTIONAL THERAPY IN SCAR PREGNANCY AFTER CESAREAN SECTION

目的甲氨蝶呤(MTX)联合米非司酮治疗与介入治疗在剖宫产术后瘢痕妊娠(CSP)中的疗效比较。方法我院2015年1月——2018年1月就诊CSP患者70例,按治疗方法分为二组。药物组给予肌肉注射MTX及口服米非司酮,治疗5 d,介入治疗组采用子宫动脉灌注MTX并行动脉栓塞,二组患者均按治疗情况行清宫术,治疗后随访3个月。检测二组患者治疗前及治疗后3个月卵巢功能,通过三维彩色多普勒超声检测二组患者治疗前后病灶处血管参数,统计二组患者临床症状恢复情况,统计二组患者治疗后距清宫术相隔时间、清宫术中出血量、住院时间、住院费用,统计二组患者不良反应发生率。结果治疗后,药物组血抗苗勒管激素(AMH)低于介入治疗组(P<0.05);治疗后,介入治疗组血管形成指数(VI)值低于药物组(P<0.05);介入治疗组临床症状恢复时间短于药物组(P<0.05);介入治疗组治疗后距清宫术相隔时间、术中出血量、住院时间小于药物组,住院费用高于药物组(P<0.05);二组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论介入治疗直接阻断子宫血供,提升局部药物浓度,改善临床症状更迅速。

Objective To compare the efficacy of methotrexate combined with mifepristone and interventional therapy in cesarean scar pregnancy(CSP).Methods Seventy cases of patients with CSP who were treated in Chengdu Women’s & Children’s Center Hospital from January 2015 to January 2018 were selected and divided into two groups according to the treatment methods.The drug group was treated with intramuscular injection of MTX and oral mifepristone for 5 d.The interventional treatment group was treated with uterine artery infusion of MTX and arterial embolization.The uterine curettage was performed in both groups according to the treatment,and the follow-up period was 3 months.The ovarian function in the two groups was measured before treatment and at 3 months after treatment.The vascular parameters in lesions in the two groups were detected by three-dimensional color Doppler ultrasonography.The clinical symptoms of the two groups were analyzed.The interval between treatment and uterine curettage,bleeding volume during uterine curettage,hospitalization time and hospitalization expenses were counted.The incidence of adverse reactions in the two groups was also counted.Results After treatment,AMH in the drug group was lower than that in the interventional treatment group(P<0.05);after treatment,the angiogenesis index(VI)in the interventional treatment group was lower than that in the drug group(P<0.05);the recovery time of clinical symptoms in the interventional treatment group was shorter than that in the drug group(P<0.05);the interval between uterine curettage and the interventional treatment group was shorter than that in the drug group.The cost of hospitalization was higher than that of drug group(P<0.05);there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Interventional therapy can directly block uterine blood supply,increase local drug concentration and improve clinical symptoms more quickly.