甲氨蝶呤灌注及子宫动脉栓塞联合清宫术对子宫瘢痕妊娠患者的疗效观察

Efficacy of Joint Curettage Technique with Methotrexate Infusion Combined with Uterine Artery Embolization in Patients with Uterine Scar Pregnancy

目的:探讨甲氨蝶呤灌注及子宫动脉栓塞联合清宫术对子宫瘢痕妊娠患者效果及对血清孕酮和β-人绒毛膜促性腺激素(β-HCG)水平的影响。方法:子宫瘢痕妊娠患者78例随机分为观察组39例与对照组39例。对照组采用开腹行病灶清除术联合口服米非司酮治疗,观察组采用甲氨蝶呤灌注+子宫动脉栓塞联合清宫术治疗。比较两组患者术中出血量、血清HCG恢复正常时间、月经恢复时间、超声瘢痕处包块消失时间,治疗前和治疗7 d后血清孕酮和β-HCG水平变化,并发症发生情况。结果:观察组术中出血量少于对照组(P<0.05);观察组血清β-HCG恢复正常时间、月经恢复时间均明显优于对照组(P<0.05);两组血清孕酮和β-HCG水平治疗后明显下降(P<0.05);观察组血清孕酮和β-HCG水平治疗后低于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论:甲氨蝶呤灌注及子宫动脉栓塞联合清宫术对子宫瘢痕妊娠患者效果明显,可明显降低患者血清孕酮和β-HCG水平,具有重要研究意义。

Objective： To investigate the efficacy of joint curettage technique with methotrexate infusion and uterine artery embolization in the patients with uterine scar pregnancy and the influence on serum progesterone and β-human chorionic gonadotropin（ β-HCG）. Methods： Totally 78 cases of uterine scar pregnancy in our hospital were selected and randomly divided into the observation group（ 39 cases） and the control group（ 39 cases） according to the random number table. The control group was treated with open surgery combined with mifepristone by oral administration,and the observation group was treated with methotrexate infusion combined with uterine artery embolization joint curettage. The amount of bleeding during the operation,normal returning time of serum HCG,menstrual recovery time,ultrasonic scar mass disappearance time,level changes of serum progesterone and β-HCG before the treatment and after 7-day treatment,and complication occurrence were compared between the groups. Results： The amount of bleeding in the observation group was less than that in the control group（ P 〈0. 05）; the normal returning time of serum HCG and menstrual recovery time in the observation group were significantly shorter than that in the control group（ P 〈0. 05）; the levels of serum progesterone andβ-HCG in the two groups were significantly decreased after the treatment（ P 〈0. 05）,and those in the observation group were lower than those in the control group（ P 〈0. 05）; the incidence of complication in the observation group was lower than that in the control group（ P 〈0. 05）. Conclusion： Methotrexate infusion combined with uterine artery embolization joint curettage technique in the patients with uterine scar pregnancy shows obvious effect,which can significantly reduce serum progesterone and β-HCG levels with important research significance.