超声引导下经腹局部注射MTX联合米非司酮治疗孕囊型切口妊娠的临床疗效评估

Value of ultrasound-guided methotrexate injection into the gestational sac combined with mifepristone for cesarean scar pregnancy

目的探讨超声引导下经腹孕囊内注射甲氨蝶呤(MTX)联合米非司酮(RU486)治疗孕囊型切口妊娠中的临床疗效及特点。方法利用穿刺针在超声引导下,对38例子宫切口区孕囊进行抽液,注入MTX治疗,术后口服米非司酮3天。比较手术成功病例术后第3、7、14、28天血β-hCG水平变化,术后第7、14及28天切口区病灶体积及周围血流变化情况。结果超声引导下孕囊内介入治疗孕囊型切口妊娠的治愈率为78.95%(30/38例),其中3例在术后出现阴道大出血,急诊行子宫动脉栓塞治疗;5例术后血β-hCG水平下降缓慢,后行超声引导下宫腔镜剥离术;26例术后第3天血β-hCG已经下降,27例第7天出现明显下降(≥50%),21例第14天血β-hCG水平转阴,第28天全部转为阴性。术后与术前病灶体积之间的差异无统计学意义(P>0.05);术后第28天病灶体积较术后第7天和第14天明显缩小(P<0.05)。术后病灶周边彩色多普勒血流信号较治疗前明显减少(P<0.01)。30例治愈病例中,18例宫内排出物中病理检测到滋养细胞,12例内未发现明确滋养细胞。结论超声引导下孕囊内注入MTX联合米非司酮治疗孕囊型切口妊娠是一种简单,安全、有效的临床治疗方法。

Objective To study the value of ultrasound(US)-guided methotrexate injection into the gestational sac combined with oral mifepristone for treatment of cesarean scar pregnancy(CSP).Methods38patients with CSP were treated by US-guided amniotic fluid aspiration and injection of methotrexate into the gestational sacs,followed by oral mifepristone for three days.Serum human chorionic gonadotropin(β-hCG)levels were monitored on day3,7,14,and28after treatment.The gestation sac size was measured and color Doppler blood flow around the sacs was monitored on day7,14and28.The findings were compared before and after treatment.Results The cure rate was78.95%(30/38).Three3patients required uterine artery chemoembolization because of massive vaginal bleeding.Five women were treated with US-guided hysteroscopy because of slow decline ofβ-hCG levels.After treatment,β-hCG level decreased in26/30women on day3,dropped more than50%in27/30on day7,was negative in21/30on day14.By day28,serumβ-hCG level was negative in all patients.The size of the gestational sac was not significantly different before and immediately after treatment(P>0.05).The sacs became significantly smaller on day28than compared to that on day7and day14(P<0.05).After treatment the blood flow around the sacs decreased significantly(P<0.01).Trophoblastic cells were found from the secretion in18patients.Conclusion US-guided injection of methotrexate into the gestational sacs combined with oral mifepristone is simple,safe and effective treatment for CSP.