甲氨蝶呤局部注射联合米非司酮口服治疗剖宫产切口瘢痕妊娠的临床研究

Clinical study of the treatment with local injection of methotrexate combining oral medication of mifepristone for cesarean section scar pregnancy

目的：探讨甲氨蝶呤（MTX）局部注射联合米非司酮口服治疗剖宫产切口瘢痕妊娠的临床疗效。方法：选取2008–2016年在我院超声诊断科行甲氨蝶呤局部注射联合米非司酮口服治疗的瘢痕妊娠患者,共计62例,行超声引导下病灶局部注射MTX（50~75 mg）,术后联合口服米非司酮（25 mg,bid,连服3 d）。治疗后每周观察患者血βHCG值下降情况,病灶大小及血流情况,病灶处肌壁厚度,阴道出血情况及肝功能指标等。结果：62例患者均于治疗后复查血βHCG逐渐下降至正常,病灶周边血流信号逐渐减少,病灶大小逐渐缩小至消失,病灶处肌壁厚度逐渐增厚,部分患者出现少量阴道出血后逐渐好转,仅1例出现阴道大量出血,未见肝功能受损现象。结论：甲氨蝶呤局部注射联合米非司酮口服治疗剖宫产切口瘢痕妊娠具有良好的临床疗效,该法简便、安全、有效,可作为瘢痕妊娠有效的微创治疗方法。

Objective： To explore the clinical efficacy of the treatment with local injection of methotrexate combining oral medication of mifepristone for the cesarean scar pregnancy. Methods： A total of 62 patients with cesarean scar pregnancy in the department of ultrasound were chosen and treated by local injection of methotrexate combining oral medication of mifepristone, MTX（50 – 75 mg） was used for local injection into nidus by ultrasonic guidance, and mifepristone（25 mg, bid, for 3 days） was used after operation. After the therapy, the clinical efficacy was observed every week（including the decrease of blood βHCG, the size and the blood flow of lesion, the thickness of muscle in the lesion, the vaginal bleeding and the liver function）. Results：After the treatment, the blood of βHCG gradually decreased to normal, the blood flow surrounding the lesion decreased, the size of lesion gradually reduced and finally disappeared, the muscle wall in the lesions gradually thickened for all the patients. Most of the patients had a little vaginal bleeding, only one patient appeared massive veginal bleeding. The patients did not have liver damage. Conclusion： Local injection of methotrexate combining oral medication of mifepristone for cesarean section scar pregnancy has a good clinical effect. It＇s a simple, safe and effective treatment with minimally invasive for the cesarean scar pregnancy.