甲氨蝶呤两种给药方式联合清宫术治疗剖宫产瘢痕妊娠的疗效比较

Comparison of Therapeutic Efficacy of 2 Kinds of Methotrexate Administration Routes Combined with Complete Curettage of Uterine Cavity in the Treatment of Cesarean Scar Pregnancy

目的:比较甲氨蝶呤静脉滴注给药与子宫动脉灌注栓塞给药联合清宫术治疗剖宫产瘢痕妊娠的临床疗效和安全性。方法:90例剖宫产瘢痕妊娠患者随机分为A组和B组,每组45例。A组患者在清宫术前给予甲氨蝶呤注射液50 mg/m^2,静脉滴注;B组患者在清宫术前采用Seldinger法穿刺插管,以甲氨蝶呤注射液50 mg/m^2与明胶海绵颗粒序贯注入子宫动脉内,复查影像学确定栓塞满意后拔除置管。两组患者均每24 h复查血人绒毛膜促性腺激素(β-HCG)水平,待血β-HCG水平降至1 000 mU/mL以下后行清宫术。比较两组患者术中出血量,术后出血量,血β-HCG恢复正常时间,月经恢复正常时间,住院时间,治疗前后瘢痕妊娠病灶直径、血β-HCG水平、并发症发生情况和不良反应发生情况。结果:B组患者术中出血量、术后出血量均显著低于A组,血β-HCG恢复正常时间、月经恢复正常时间和住院时间显著短于A组,总并发症发生率显著低于A组,差异均有统计学意义(P<0.05)。用药前,两组患者瘢痕妊娠病灶直径比较,差异无统计学意义(P>0.05);清宫术前,两组患者瘢痕妊娠病灶直径显著小于同组用药前,且B组显著小于A组,差异均有统计学意义(P<0.05)。用药前,两组患者血β-HCG水平比较,差异无统计学意义(P>0.05);清宫术前后,两组患者血β-HCG水平显著低于同组用药前,且B组显著低于A组,差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:相较于静脉滴注给药,甲氨蝶呤子宫动脉灌注栓塞给药联合清宫术治疗剖宫产瘢痕妊娠可有效减少患者围术期出血量,促进血β-HCG水平降低和月经恢复,并有助于降低相关并发症发生风险,安全性较好。

OBJECTIVE： To compare clinical efficacy and safety of intravenous dripping of metbotrexate and uterine arterial perfusion embolization combined with complete curettage of uterine cavity （CCUC） in the treatment of cesarean scar pregnancy （CSP）. METHODS： A total of 90 CSP patients were randomly divided into group A and B, with 45 cases in each group. Group A was given Methotrexate （MTX） injection 50 mg/m2 intravenously before CCUC. Group B received Seldinger catheterization in su- pine position before CCUC, and was given sequential infusion of MTX injection 50 mg/m2 and gelatin sponge particles into the uterine artery; the catheter was removed after satisfactory embolization by imaging examination. The levels of β-HCG of 2 groups were reexamined every 24 h, and CCUC was performed when serum β-HCG level was below 1 000 mU/mL. Perioperative bleeding volume, postoperative bleeding volume, the time of blood β-HCG returning to normal, the time of menstruation returning to nor- mal, hospitalization time as well as the lesion diameters, the levels of blood β-HCG, the occurrence of compliance and ADR be- fore and after treatment were compared between 2 groups. RESULTS： The intraoperative bleeding amount and postoperative bleed- ing amount of group B were significantly lower than those of group A, while the time of blood β-HCG returning to normal, the time of menstruation returning to normal and hospitalization time were significantly shorter than group A, and the incidence of total compliance was significantly lower than group A, with statistical significance （P〈0.05）. Before medication, there was no statisti- cal significance in lesion diameters between 2 groups （P〉0.05）. Before CCUA, the lesion diameters of 2 groups were significantly smaller than before medication, and the group B was significantly smaller than group A, with statistical significance （P〈0.05）. Be- fore medication, there was no statistical significance in blood β-HCG levels between 2 groups （P〉0.05）. Before and after CCUC, blood β-HCG levels of 2 groups were significantly lower than before medication, and the group B was significantly lower than group A, with statistical significance （P〈0.05）. There was no statistical significance in the incidence of ADR between 2 groups （P〉0.05）. CONCLUSIONS： Compared with methotrexate by intravenous drip, methotrexat by uterine artery embolization com-bined with CCUC for CSP can effectively reduce intraopera- tive bleeding amount, promote the decrease of blood β-HCGand menstrual recovery, and contribute to the reduction of complication risk with good safety.