中西医结合治疗剖宫产瘢痕妊娠的临床观察

Clinical Observation on Combined Treatment of Traditional Chinese Medicine and Western Medicine for the Treatment of Cesarean Scar Pregnancy

目的 探讨中西医结合治疗剖宫产瘢痕妊娠的临床疗效。方法 对2010年5月至2012年12月在湖南省妇幼保健院妇科住院治疗的未破裂型剖宫产瘢痕妊娠患者进行回顾性分析，将其归纳为对照组和观察组，对照组24例，给予单纯M T X治疗后宫腔镜下清宫，观察组101例，给予中药结合M T X治疗后再行宫腔镜下清宫。对比分析两组患者治疗成功率、血清人绒毛膜促性腺激素（β‐HCG）和子宫不均质回声体积平均下降速度及不良反应发生情况。结果 ①观察组首次清宫成功率明显高于对照组，差异有统计学意义（ P ＜0．05）；②观察组清宫过程中出现阴道大出血需要中转开腹手术或需用水囊压迫止血比率低于对照组，但其差异无统计学意义（ P ＞0．05）；③观察组β‐HCG的平均下降速度明显快于对照组，差异有统计学意义（ P ＜0．05）；④观察组子宫下段不均质回声体积的平均下降速度与对照组比较无统计学差异；⑤观察组不良反应发生率与对照组比较无统计学差异。结论 中西医结合治疗剖宫产瘢痕妊娠成功率、β‐HCG平均下降速度均优于单纯西医治疗法，值得临床推广。

Objective]To explore clinical efficacy of combined treatment of traditional Chinese medicine and Western medicine for the treatment of cesarean scar pregnancy .[Methods]Clinical data of patients with unruptured cesarean scar pregnancy hospitalized in maternal and child health hospital of Hunan province from May 2010 to Dec . 2012 were analyzed retrospectively and divided into control group and observation group .The control group（ n=24） underwent clearing the pericardium under hysteroscopy after simple MTX treatment .The observation group（ n =101） underwent clearing the pericardium under hysteroscopy after traditional Chinese medicine combined with MTX treatment .The treatment success rate ,average decline speed of serum human chorionic gonadotropin（β‐HCG） and u‐terine heterogeneous echo volume and adverse reaction of two groups were compared and analyzed .[Results]The first success rate of clearing the pericardium in observation group was obviously higher than that in control group ,and there was significant difference（ P〈0 .05） .The rates of laparotomy or water sac compression for vaginal hemorrhea in observation during the operation were lower than those in control group ,and there was significant difference（ P〉0 .05） .The average decline speed ofβ‐HCG in observation group was obviously faster than that in control group（ P〈0 .05） .There was no significant difference in average decline speed of uterine heterogeneous echo volume between two groups（ P〉0 .05） .There was no significant difference in the incidence of adverse reaction between two groups（ P〉0 .05） .[Conclusion] The success rate and the average decline speed ofβ‐HCG in observation group receiving the combined treatment of traditional Chinese medicine and Western medicine are better than simple Western medicine treatment .Therefore ,the combined treatment of traditional Chinese and Western medicine is worthy to be popular‐ized .