米非司酮+甲氨蝶呤用于瘢痕妊娠的疗效分析

Curative effect of Mifepristone and Methotrexate on scar pregnancy

目的 探讨米非司酮＋甲氨蝶呤对瘢痕妊娠的疗效及安全性。方法 选择易县妇幼保健院和解放军总医院2008年1月至2012年12月收治的200例子宫切口瘢痕妊娠患者，随机将患者分为治疗组（ n＝100例）和对照组（ n＝100例）。对照组给予甲氨蝶呤50mg，阴道超声注入，2次／日，连续3天。治疗组在对照组基础上给予米非司酮50mg，口服，2次／日，连续3天。评定两组治疗1个月的疗效，记录其不良反应。结果 治疗组治愈率为95．0％，高于对照组的71．0％（χ^2=10．235，P＜0．05）。治疗组包块消失时间、血β－人绒毛膜促性腺激素转阴时间均少于对照组（t值分别为8．772、8．993，均P＜0．05）。治疗组白细胞降低、肝酶升高、消化道炎症、口腔炎、发热的发生率均低于对照组（χ^2分别为8．553、9．005、7．885、8．647、9．541，均P＜0．05）。结论 米非司酮＋甲氨蝶呤治疗子宫切口瘢痕妊娠的治愈率高，不良反应发生率低，治疗方法简单，值得推广使用。

Objective To explore the curative effect and safety of Mifepristone combined with Methotrexate on scar pregnancy .Methods Totally 200 patients with uterine incision scar pregnancy in Yixian Maternity and Child Care Center and General Hospital of the People ’ s Liberation Army between January 2008 and December 2012 were chosen in the study , and they were randomly divided into treatment group （ n=100） and control group （ n=100 ） .The control group was given Methotrexate , and the treatment group was additionally given oral Mifepristone based on the therapy for the control group .Methotrexate was given 50 mg for 3 days by vaginal ultrasound injection , twice per day.The curative effects of two groups after one month of treatment were assessed , and the adverse reactions were recorded .Results The cure rate of the treatment group was 95.0%, which was significantly higher than the control group of 71.0% （χ^2=10.235,P〈0.05）. The bag piece disappearing time and blood β-hCG turning negative time were significantly less in the treatment group than in the control group （t value was 8.772 and 8.993, respectively, both P 〈0.05）.Compared with the control group , the incidence of blood cells reduce , liver enzymes elevation , digestive tract inflammation , oral inflammation , and fever was lower in the treatment group （χ^2value was 8.553, 9.005, 7.885, 8.647 and 9.541, respectively, all P〈0.05）.Conclusion Mifepristone combined with Methotrexate has high curative rate and low incidence of adverse reactions on scar pregnancy .The method is simple and can be used widely in clinics .