米非司酮联合米索前列醇在不同特征瘢痕子宫中期引产中的疗效及安全性分析

The Efficacy and Safety of Mifepristone Combined with Misoprostol on Mid-term Abortion of Different Characteristics of Scar Uterine Pregnancies

目的：观察米非司酮联合米索前列醇对不同特征瘢痕子宫妊娠中期引产的效果及安全性。方法：回顾性分析2012年6月—2015年5月海南省海口市解放军第187医院妇产科收入的102例瘢痕子宫妊娠患者的病历资料,比较不同年龄（〈35岁vs.≥35岁）、剖宫产手术史（〈1年vs.1~2年vs.〉2年）和子宫愈合情况（均匀连续vs.非均匀连续,或无薄弱区vs.有薄弱区）患者的引产宫缩发动时间、排出孕囊时间、阴道出血量、流产程度和相关不良反应发生情况。结果：子宫瘢痕无薄弱区患者的胎儿及其附属物排出时间短于有薄弱区者（t=-2.57,P=0.01）,且有无薄弱区患者流产程度的分布也不同（χ2=11.92,P〈0.01）;非均匀连续性子宫愈合患者的不良反应总发生率高于均匀连续性子宫愈合患者（χ2=6.32,P=0.01）。结论：米非司酮联合米索前列醇对瘢痕子宫妊娠中期有较好引产效果,但受到子宫恢复情况的影响,对子宫瘢痕有薄弱区、不均匀连续者应结合其他方法及使用更多监护措施进行治疗。

Objective： To compare the efficacy and safety of Mifepristone combined with Misoprostol on abortion of scaruterine pregnancies with different characteristics in mid-term. Methods： A retrospective analysis of medical records of 102patients with scar uterine pregnancies during June 2012 to May 2015 in our hospital, and Studentst and chi-square test wereused to compare the differences of contractions launch time, the discharge time of the gestational sac, vaginal bleeding,miscarriage and degree-related adverse reactions among the patients with different age （ 〈35 years vs. ^35 years）, history ofcesarean section （〈 1 yeari;5. 1-2 years vs. 〉 2 years） and uterine surgery healing abortion （uniform continuous vs. nonuniformcontinuous, or weak area vs. no weak area）. Results： The discharge time of fetus and its appendages in patients with noweak areas of uterine scar was shorter than that had weak areas of uterine scar （t= -2.57, P=0.01）, and the distribution of thedegrees of abortion was also significant difference between the patients with weak area and without weak area （χ2=11.92, P〈C0.01）; the total incidence of adverse effects in patients with non-uniform continuous occurrence of uterine healing wassignificantly higher than that with uterine healing uniform continuity （χ2=6.32, P=0.01）. Conclusions： Mifepristone combinedwith Misoprostol was efficient for abortion of scar uterine pregnancies in mid-term that effected by the recovery of the uterus, andpatients with weak area in uterine scar and non-uniform continuous occurrence of uterine healing should be further treated andguardianship.