甲氨蝶呤介入治疗剖宫产术后子宫瘢痕妊娠的临床观察

Clinical Observation of Methotrexate in the Interventional Treatment of Cesarean Scar Pregnancy

目的:观察甲氨蝶呤介入治疗剖宫产术后子宫瘢痕妊娠(CSP)的疗效和安全性。方法:40例CSP妇女随机分为对照组(20例)和观察组(20例)。对照组妊娠妇女给予甲氨蝶呤注射液1 mg/kg,肌内注射,每日1次;米非司酮片25 mg,口服,每日2次,均连用5 d。观察组妊娠妇女给予甲氨蝶呤注射液50 mg,经子宫动脉注入后用明胶海绵栓塞。两组妊娠妇女给药结束后检查血人绒毛膜促性腺激素(β-HCG)值,待β-HCG值降至≤2 000 U/L后行清宫术;血β-HCG值>2 000 U/L者继续予以口服米非司酮片25 mg,每日2次,至血β-HCG值降至≤2 000 U/L后行清宫术。观察两组妊娠妇女清宫出血量、确诊距手术间隔时间、术后血β-HCG值恢复正常所需时间,记录不良反应发生情况。结果:观察组妊娠妇女清宫出血量显著低于对照组,确诊距手术间隔时间、术后血β-HCG值恢复正常所需时间显著短于对照组,差异均有统计学意义(P<0.05)。两组妊娠妇女治疗期间均未见明显不良反应发生。结论:甲氨蝶呤介入治疗CSP可有效减少清宫出血,缩短清宫手术等待时间及血β-HCG值恢复至正常的时间,且安全性较好。

OBJECTIVE： To observe the efficacy and safety of methotrexate in the interventional treatment of cesarean scar pregnancy （CSP）. METHODS： 40 CSP women were randomly divided into control group （20 cases） and observation group （20 cases）. Control group pregnant women received methotrexate 1 mg/kg, intramuscular injection, once a day; mifepristone 25 mg, orally, twice a day, for 5 d. Observation group pregnant women received methotrexate 50 mg, gelatin sponge embolization was conducted after uterine artery injection. Human chorionic gonadotropin （fl-HCG） value was detected after administration, then curettage was conducted until β-HCG value decreased to less than or equal to 2 000 U/L; pregnant women still received mifepristone 25 mg iffl-HCG value was higher than 2 000 U/L, then curettage was conducted until fl-HCG value decreased to less than or equal to 2 000 U/L. The amount of bleeding, time distance to curettage, the time of fl-HCG value to normal in 2 groups were observed, and the incidence of adverse reactions was recorded. RESULTS ： The amount of bleeding in observation group was significantly lower than control group, time distance to curettage and the time of β-HCG value to normal were significantly shorter than control group, with statistical significances （P〈0.05）. And there were no obvious adverse reactions in 2 groups. CONCLUSIONS： Methotrexate can effectively reduce the bleeding in the interventional treatment of CSP, shorten the time distance of diagnosed to curetrage and the time of β-HCG value to normal, with good safety.