天花粉蛋白联合甲氨蝶呤治疗剖宫产术后子宫瘢痕妊娠的疗效观察

Clinical efficacy of radix trichosanthis combined with methotrexate on cesarean scar pregnancy

目的:观察天花粉蛋白联合甲氨蝶呤(MTX)治疗剖宫产术后子宫瘢痕妊娠(CSP)的疗效。方法:选择2013年3月至2015年7月在宁夏回族自治区固原市隆德县人民医院接受治疗的剖宫产术后CSP患者94例,按随机数字表法分为观察组和对照组,每组47例。观察组给予天花粉蛋白注射液联合MTX治疗,对照组单纯给予MTX治疗。对比两组临床疗效、生育功能恢复情况、相关临床指标及不良反应发生情况。结果:观察组治疗总有效率为95.7%,显著高于对照组的74.5%(P<0.05)。与对照组比较,观察组阴道流血时间、血清β-人绒毛膜促性腺激素(β-HCG)水平恢复时间、月经恢复时间及住院时间均显著缩短(均P<0.05)。两组患者在治疗后2d、7d的血清β-HCG水平、治疗后7d的孕囊直径及MTX再次使用率比较,差异均无统计学意义(均P>0.05)。观察组总不良反应发生率显著低于对照组(P<0.05)。结论:天花粉蛋白联合MTX治疗剖宫产术后CSP的疗效优于单独使用MTX,可减少术中出血,缩短住院时间,促进生育功能恢复,不良反应少,具有较高的临床应用价值。

Objective： To investigate the clinical efficacy of radix trichosanthis combined with methotrexate on cesarean scar pregnancy. Methods： 94 patients with cesarean scar pregnancy in our hospital from March 2013 to July 2015 were selected and randomly divided into a control group （n ：47） and an observation group （ n =47）. The patients in the control group were treated with MTX, while those in the observation group were treated with MTX combined with radix trichosanthis. The clinical curative effect, recovery of fertility function, the clinical index and adverse reactions between the two groups were compared. Results： The curative effect of the observation group was obviously superior to that of the control group （95.7%o vs. 78.7, P d0. 05）. The vaginal bleeding, β-HCG recovery duration, menstruation recovery and hospital days in the observation group were shorter than those in the control group （P〈0.05）. There were no significant differences in β-HCG level at day 2 and 7 after treatment, gestational sac diameter at day 7 after treatment and MTX reuse rate between the two groups （P〈0. 05）. The adverse reactions in the observation group were significantly lower than those in the control group （P〈0.05）. Conclusion： Radix tricho- santhis combined with MTX for the treatment of cesarean scar pregnancy was more effective than MTX alone. It could reduce vaginal bleeding, shorten hospital days, promote reproductive function recovery, and had less adverse reactions.