子宫动脉栓塞与甲氨蝶呤联合氟尿嘧啶治疗子宫切口妊娠的对比研究

Comparative Study of Uterine Artery Chemoembolization and Methotrexate with 5-fluorouracil in the Treatment of Cesarean Scar Pregnancy

目的比较子宫动脉栓塞治疗与甲氨蝶呤联合氟尿嘧啶治疗子宫切口妊娠的疗效。方法回顾性分析2000年1月至2013年9月我院100例子宫切口妊娠患者临床资料,根据治疗方法分为介入栓塞组与全身用药组,对两组临床指标进行比较。结果介入栓塞组阴道出血量较全身用药组少,血β-hCG降至正常的时间、平均住院时间均较全身用药组短,组间比较差异有统计学意义(P<0.05);介入栓塞组治疗成功率96.0%(48/50),全身用药组成功率86.0%(43/50),两组比较差异无统计学意义(P>0.05);组间不良反应比较差异无统计学意义(P>0.05)。术后随访两组月经恢复时间、激素水平无显著差别。结论子宫动脉灌注化疗栓塞术后行清宫术治疗子宫切口妊娠更安全有效,但技术要求高;而MTX联合5-Fu全身用药后清宫术治疗子宫切口妊娠,技术要求低,不需特殊设备,更适合在基层医院开展。

Objective To compare the efficacy of uterine artery chemoembolization （UAE）and methotrexate （MTX）with 5-fluorouracil（5-Fu） in the treatment of cesarean scar pregnancy（CSP）. Methods The clinical data of 100 cases with CSP were analyzed retrospectively. According to the preference of the patient, the 100 cases were divided into the interventional embolization group and the systemic medication group, Clinical indicators after treatment were compared between the two groups. Results The interventional embolization group was less vaginal bleeding, shorter hospitalization time and serum β-hCG dropped to normal time than the systemic medication group with significant differeence （ P 〈 0. 05 ）. The success rate of the interventional embolization group was 96. 0% （48/50） ,and the systemic medication group was 86. 0% （43/50） ,but the success rate between the two groups differeence was not significant（ P 〉 0. 05 ）. Adverse reactions between the two groups differeence was not significant（ P 〉 0. 05 ）. During the follow-up period, no significant difference in the recovery time of the mental cycle and the hormone levels were found between the two groups （P 〉 0. 05 ）. Conclusion Curettage after UAE is safer and more effective for CSP, while this needs higher technology requirement;Curettage after the systemic medication of MTX and 5-Fu can be more suitably adopted in the primary hospital with lower technology requirement and without special device of interventional treatment.