剖宫产术后子宫瘢痕妊娠不同治疗方法的临床研究

A clinical study on treating uterine scar pregnancy after cesarean section by different therapies

目的:比较剖宫产术后切口瘢痕妊娠不同治疗方法的疗效。方法:将121例切口瘢痕妊娠患者分为两组,甲氨蝶呤(MTX)+西药组(60例)用MTX+米非司酮+米索+刮宫术联合治疗;MTX+中药组(61例)用MTX+中药方剂+刮宫术联合治疗。治疗过程中,比较各组疗效、β-HCG水平变化、第10天的瘢痕子宫妊娠包块最大横径;药物不良反应包括肝功能损害及消化道症状。结果:MTX+西药组和MTX+中药组治愈率分别为95.0%和93.4%,经χ~2检验无统计学差异(P>0.05);MTX+中药组血β-HCG水平在治疗第5天和第10天低于MTX+西药组,恢复正常水平时间也少于MTX+西药组,差异有统计学意义(P<0.01);治疗第10天,瘢痕子宫妊娠包块明显小于MTX+西药组,差异有统计学意义(P<0.01);治疗第10天,MTX+西药组血清丙氨酸氨基转移酶水平和消化道症状发生率均高于MTX+中药组,差异有统计学意义(P<0.01)。结论:MTX+中药+刮宫术与MTX+米非司酮+米索前列醇+刮宫术的疗效无差异,但使用MTX+中药+刮宫术后,血β-HCG水平下降快、包块缩小更明显,肝功能异常与消化道症状等不良反应少,是目前值得推广应用的技术。

Objective:To compare the effectiveness of different methods on cesarean scar pregnancy after cesarean section.Methods:121cases were divided into the MTX+western medicine group(60cases),treated with MTX,mifepristone plus misoprostol and curettage,and the MTX+TCM medicine group(61cases),treated with MTX+traditional Chinese medicine and curettage.Results:The cured in the MTX+western medicine group and MTX+TCM medicine group were95.0%and93.4%respectively,with no statistical difference inχ2test(P>0.05);the bloodβ-HCG level in the MTX+TCM medicine group is lower than the MTX+western medicine group at5th day and10th day;the time of recover to normal time is less than the MTX+western medicine group(P<0.01);uterine scar pregnancy mass was less than that in the MTX+western medicine group at10th day(P<0.01).The serum alanine aminotransferase level and incidence rate of gastrointestinal symptoms in the MTX+western medicine group were higher(P<0.01).Conclusion:No difference in the efficacy between two groups,but bloodβ-HCG level and mass were decreased more rapidly in the MTX+TCM medicine group,with less abnormal liver function and adverse reactions of digestive tract symptoms,and is worthy of popularization and application.