宫腔镜联合甲氨蝶呤+米非司酮治疗子宫切口妊娠疗效观察

Observation of the curative effect of hysteroscopy combined with mifepristone and methotrexate in the treatment of cesarean section pregnancy

目的探讨宫腔镜联合甲氨蝶呤(methotrexate,MTX)+米非司酮治疗子宫切口妊娠(cesarean scar pregnancy,CSP)的疗效。方法回顾性分析2012年1月至2014年1月长沙市妇幼保健院妇科收治的52例CSP患者的临床资料,按照不同治疗方法分为观察组(38例)和对照组(14例),观察组采用MTX肌内注射同时口服米非司酮治疗,监测血β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)下降后,再在B超引导下行宫腔镜电切术;对照组患者自愿选择MTX+米非司酮药物保守治疗。比较两组患者β-HCG下降至正常所需时间及并发症发生情况。结果观察组中36例顺利完成手术,1例因术中大出血止血困难,立即中转开腹行子宫切口修补术,1例术后因阴道流血多行宫腔球囊压迫治疗后阴道流血停止。对照组2例在保守治疗过程中大出血,立即行开腹子宫病灶清除术及子宫修复,3例因保守治疗后β-HCG下降不理想,在MTX治疗2个疗程后行宫腔镜手术。观察组β-HCG下降至正常的时间明显短于对照组,且术后并发症发生例数少于对照组(P<0.05)。结论宫腔镜电切联合MTX+米非司酮治疗子宫切口妊娠安全有效,优于药物保守治疗。

Objective To explore the curative effect and safety of hysteroscopy combined with mifepristone and methotrexate（ MTX） in the treatment of cesarean section pregnancy. Methods A retrospective analysis of clinical data of 52 cases of cesarean scar pregnancy women treated in Maternal and Child Health Hospital of Changsha from Jan. 2012 to Jan. 2014 was conducted. The cases were divided into observation group and control group according to the treatment methods. The observation group with 38 cases were treated with MTX intramuscular injection and oral mifepristone at first,then underwent hysteroscopic surgery in B ultrasound guidance after HCG decreased. The control group with 14 cases selected MTX and mifepristone conservative treatment voluntarily. Compared the time taken to decrease HCG to normal and complications of the two groups. Results The operations of 36 cases in the observation group were successful,only 1 case immediately converted to laparotomy for repair of uterine because of intraoperative hemostasis difficulty. 1 case stopped postoperative vagina bleeding after the treatment of uterine balloon compressiontherapy. 2 patients in the control group bled a lot during conservative treatment,immediately underwent uterine debridement and uterine repair. 3 patients turned to hysteroscopic operation at last because HCG decreased less after 2 cycles of MTX and mifepristone in the conservative treatment. The time for HCG to decrease to normal in the observation group was shorter than the control group,and less postoperative complications were found in the observation group（ P〈0. 05）. Conclusion Hysteroscopy combined with mifepristone and MTX in the treatment of cesarean section pregnancy is effective and safe,better than conservative treatment and is worth to promote in clinic.