对于剖宫产瘢痕妊娠不同治疗方法的分析

Analysis on Different Treatment Methods for Cesarean Scar Pregnancy

目的 比较甲氨蝶呤灌注＋介入治疗与传统甲氨蝶呤配伍米非司酮治疗剖宫产瘢痕妊娠的临床效果。方法 选择2012年1月-2015年3月经术后确诊为剖宫产瘢痕妊娠患者共589例。告知患者2种治疗方案,根据患者自行选择结果进行分组。其中甲组234例,为应患者要求选择传统药物治疗方案：即肌肉注射甲氨蝶呤20 mg,1次/d,共5 d;口服米非司酮50 mg,1次/d,共3~5 d;结合B型超声局部妊娠组织血流情况及患者肝功能决定是否进一步追加用药。乙组255例,为应患者要求选择子宫动脉灌注＋介入栓塞术。两组患者年龄、血β-人绒毛膜促性腺激素及宫腔切口处妊娠囊大小差异均无统计学意义（P〉0.05）。比较两组治疗效果。结果 乙组术中出血量、血β-人绒毛膜促性腺激素降至正常时间、住院时间均少于甲组,差异有统计学意义（P〈0.05）;乙组重复清宫、重复用药、肝功能受损的发生率均低于甲组,差异有统计学意义（P〈0.05）;两组子宫切除率差异无统计学意义（P〉0.05）。结论 在剖宫产瘢痕妊娠治疗方案中,甲氨蝶呤灌注＋介入治疗的疗效及安全性均高于传统的甲氨蝶呤配伍米非司酮治疗。

Objective To compare the clinical efficacy of methotrexate perfusion combined with interventional treatment and the traditional treatment with methotrexate and mifepristone for cesarean scar pregnancy. Methods A total of 589 patients diagnosed with cesarean scar pregnancy after surgery between January 2012 and March 2015 in our hospital were selected to be our study sub）ects. The patients were informed of the two kinds of treatment, and based on their own will, they were arranged into corresponding groups. Group A had 234 patients who were willing to undergo the conventional therapy： intramuscular in）ection of methotrexate （20 mg, once per day for 5 days）; oral mifepristone （50 mg once per day for 3 to 5 days）; and the continuation of drugs was determined by local pregnancy tissue blood flow on B ultrasound and liver function of the patients. Group B had 255 patients who selected uterine artery perfusion and arterial embolism. There was no significant difference in terms of age, serum human chorionic gonadotrophin （HCG） and uterine incision gestation sac size between the two groups of patients （P 〉 0.05）. Then we compared the treatment effect between the two groups. Result The differences in the amount of bleeding, the time of blood HCG dropped to normal, and hospitalization duration between the two groups were significant （P 〈 0.05）, while in the rate of hysterectomy, drug- induced liver injury were not （P 〈 0.05）. Conclusion Methotrexate perfusion combined with interventional treatment is better than the traditional treatment with methotrexate and mifepristone for cesarean scar pregnancy in terms of clinical efficacy and safety.