甲氨蝶呤、米非司酮联合化瘀消癥汤治疗子宫瘢痕妊娠的临床观察

Clinical Observation of Methotrexate,Mifepristone Combined with Huayu Xiaozheng Decoction in the Treatment of Uterine Scar Pregnancy

目的:观察甲氨蝶呤(MTX)、米非司酮联合化瘀消癥汤治疗子宫瘢痕妊娠的疗效和安全性。方法:86例子宫瘢痕妊娠患者随机分为对照组(43例)和观察组(43例)。对照组患者于超声引导下局部注射MTX 50 mg,每日1次+米非司酮片50 mg,口服,每日2次;观察组患者在对照组治疗的基础上给予化瘀消癥汤100 ml,温服,每日2次。两组疗程均为15 d。观察两组患者的临床疗效,治疗前及治疗后第7、14、28天血人绒毛膜促性腺激素(HCG)水平,包块直径及不良反应发生情况。结果:观察组患者总有效率显著高于对照组,差异有统计学意义(P<0.05)。治疗后第7、14、28天两组患者血HCG水平和包块直径均显著低于同组治疗前,随治疗时间延长逐渐降低,且研究组低于对照组,差异均有统计学意义(P<0.05或P<0.01)。两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论:MTX、米非司酮联合化瘀消癥汤治疗子宫瘢痕妊娠的疗效和安全性均较好。

OBJECTIVE：To investigate the efficacy and safety of methotrexate（MTX）,Mifepristone combined with Huayu xiaozheng decoction in the treatment of uterine scar pregnancy. METHODS：86 patients with uterine scar pregnancy were randomly divided into control group（43 cases）and observation group（43 cases）. Control group orally received 50 mg ultrasound-guided local injections of MTX,once a day＋50 mg Mifepristone tablet,twice a day;observation group additionally received 100 ml Huayu xiaozheng decoction,twice a day with warm temperature. The treatment course for both groups was 15 d. Clinical efficacy,HCG levels,mass diameter before and after 7,14 and 28 d of treatment,and the incidence of adverse reactions in 2 groups were observed. RESULTS：The total effective rate in observation group was significantly higher than control group,the difference was statistically significant（P〈0.05）. HCG levels and mass diameter after 7,14 and 28 d were significantly lower than before,it gradually reduced by time prolonged,and research group was lower than control group,the differences were statistically significant（P〈0.05 or P〈0.01）. And there was no significant difference in the incidence of adverse reactions（P〉0.05）. CONCLUSIONS：Ultrasound-guided local injections of MTX combined with Huayu xiaozheng decoction shows good efficacy and safety in the treatment of uterine scar pregnancy