两种治疗剖宫产切口瘢痕妊娠方法的疗效对比

Comparison of therapeutic effects of two treatment methods on cesarean scar pregnancy

目的研究甲氨蝶呤联合米非司酮治疗与介入治疗在剖宫产切口瘢痕妊娠中的临床疗效。方法选取2012年6月至2016年6月收治的100例剖宫产切口妊娠患者作为研究对象,采取数字抽签法随机分为A组和B组,各50例。A组患者给予甲氨蝶呤联合米非司酮治疗,B组患者给予介入治疗。两组患者的血β-HCG值均降至1 000 U/L后,对患者进行清宫手术。比较两组患者的术中出血量、术后血β-HCG值恢复正常时间、月经恢复时间、平均给药次数以及中转子宫切除手术率。结果A组患者的术中出血量为(64.35±6.87)mL,血β-HCG值恢复正常时间为(6.97±1.53)d,月经恢复时间为(68.13±10.45)d,B组分别为(49.62±5.14)mL、(5.12±1.27)d、(56.38±9.26)d,两组比较,B组各项指标明显优于A组(P<0.05)。A组平均给药次数为(3.84±1.26)次,高于B组的(2.15±1.09)次(P<0.05)。A组中转子宫切除手术率为14.00%(7/50),B组中转子宫切除手术率为2.00%(1/50),B组明显低于A组(P<0.05)。结论在剖宫产切口瘢痕妊娠中,介入治疗的临床疗效较甲氨蝶呤联合米非司酮治疗方案更加显著,能够有效减轻患者的术中痛苦,加快术后恢复速度,降低子宫切除率。

Objective To study the clinical effect of methotrexate combined with mifepristone and interventional therapy in the treatment of cesarean scar pregnancy. Methods One hundred cases of patients with incision pregnancy from June 2012 to June 2016 were selected as study objects, and randomly divided into group A and group B, with 50 cases in each group. Patients in group A were treated with methotrexate combined with mifepristone, and patients in group B were treated with interventional therapy. When the serum 13-HCG of patients in the two groups decreased to 1 000 U/L, uterine curettage were adopted to the patients. The blood loss during operation, time for serum ±-HCG recovery after operation, menstruation recovery time, average interval of drug administration and the conversion rate of hysterectomy between the two groups were compared. Results In group A, the blood loss was （64.35±6.87） mL, serum 13-HCG recovery time was （6.97± 1.53） d, menstruation recovery time was （68.13±10.45） d; while in group B, they were （49.62±5.14） mL, （5.12±1.27） d and （56.38±9.26） d respectively, the indicators of the group B were better than those of group A （P〈0.05）. The average interval of drug administration in group A was （3.84±1.26）, which was higher than （2.15±1.09） in group B （P〈0.05）. The conversion rate of hysterectomy in group A was 14.00% （7/50）, while the rate of conversion of hysterectomy in group B was 2.00% （1/50）, the difference between the two groups was statistically significant （P〈0.05）. Conclusion The clinical efficacy of interventional therapy in the treatment of incision pregnancy is more significant than that of methotrexate combined with mifepristone treatment, which can effectively reduce the pain during the operation and speed up the recovery rate.