宫内局部注射与肌内注射甲氨蝶呤治疗剖宫产瘢痕妊娠的疗效对比观察

Efficacy comparison between transvaginal ultrasound intervention and intrauterine local injection for treating cesarean scar pregnancy

目的:对比分析经阴道超声介入引导注射与肌肉注射甲氨喋林治疗剖宫产瘢痕妊娠的临床疗效。方法:选取2016年3月~2018年3月来本院治疗的瘢痕子宫妊娠患者68例,按随机数字表法分两组各34例。介入组经阴道超声介入引导局部注射甲氨蝶呤治疗,注射组单次肌肉注射甲氨蝶呤治疗,比较两组治疗效果、血清相关指标以及不良反应发生情况。结果:介入组清宫出血量、血HCG和月经恢复时间、出院时间及追加甲氨蝶呤次数均小于注射组(P<0.05);治疗7d后,介入组治愈率(97.1%)高于注射组(64.7%),追加用药后介入组治愈率(100%)仍高于注射组(79.4%)(均P<0.05);治疗前两组血清PAPP-A、VEGF、INH-A、病灶部位血供相关指标无差异(P>0.05),治疗后3d、7d时介入组各项指标均低于注射组(P<0.05),不良反应发生率(11.8%)低于注射组(35.3%)(t=15.387,P<0.05)。结论:经阴道超声介入引导局部注射甲氨蝶呤对剖宫产瘢痕妊娠患者疗效更显著,不良反应发生率较低,值得临床推广应用。

Objective：To compare the clinical efficacy of transvaginal ultrasound interventional injection with intramuscular injection of methotrexate for treating cesarean scar pregnancy（CSP）.Method：68 patients with CSP from March 2016 to March 2018 were randomly divided into observation group and control group according random number table（34 cases in each group）.The patients in observation group were treated by local transvaginal injection of methotrexate under ultrasound,and patients in control group were treated by a single intramuscular injection of methotrexate.The effect of cure,the serum correlation index,and the rate of adverse reactions of patients were compared between the two groups.Results：In observation group,the amount of hemorrhage,the time of returning to normal HCG,the recovery time of menstruation,and the time of discharge of patients,and the number of needing additional methotrexate in observation group were all significant less than those of patients in control group（P〈0.05）.After 7 days of treatment,the cure rate of patients in observation group was 97.1%,which was significant higher than that of patients（64.7%）in control group（P 0.05）.After patients were given additional medication,the cure rate of patients（100.0%）in observation group was still significant higher than that of patients（79.4%）in control group（P〈0.05）.There was no significant difference in level of serum PAPP A,VEGF,and INH A,and rate of blood supply between the two groups before treatment（P〉0.05）,but on the 3 and the 7 day after treatment,the above indexes of patients in observation group were significant lower than those of patients in control group（P〈0.05）.The incidence of adverse reactions of patients（11.8%）in observation group was significant lower than that of patients（35.3%）in control group（t=15.39,P〈0.05）.Conclusion：The local injection of methotrexate transvaginal ultrasound for treating CSP has perfect effectiveness,and has less adverse reaction,so it is worthy of clinical application.