不同疗程药物保守治疗产后胎盘植入残留宫内的临床效果

Clinical effect of conservative treatment with different courses of medication for intrauterine remnants of postpartum placenta increta

目的:比较不同疗程甲氨蝶呤联合米非司酮治疗胎盘植入产妇的临床疗效。方法:选取花都区人民医院妇产科2014年9月至2016年3月间收治的胎盘植入产妇104例,采用随机数字法将其分为短疗程组和长疗程组,每组各52例。两组患者均给予脐静脉注射甲氨蝶呤和口服米非司酮治疗,其中短疗程组患者连续治疗1周,长疗程组患者连续治疗4周。比较两组患者的临床疗效、各指标恢复时间及不良反应发生率。结果:两组患者的治愈率均为100.00%;长疗程组患者β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)转阴、血清肌酸激酶(creatine kinase,CK)转阴及肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)转阴及孕酮值转阴的时间均低于短疗程组(P<0.01),长疗程组的胎盘完全清除时间、月经恢复时间及住院时间均低于短疗程组(P<0.01),两组的治疗费用和不良反应发生率比较差异无统计学意义(P>0.05)。结论:增加甲氨蝶呤与米非司酮给药时间,不仅能提高胎盘植入的治疗疗效,且不会增加不良反应和治疗费用,治疗安全性高,值得在临床推广。

Objective:To compare the clinical efficacy of different courses of methotrexate combined with mifepristone in treatment of placenta increta.Methods:104 cases of placenta increta enrolled from September 2014 to March 2016,were randomly divided into the short course group and long course group,52 cases in each group.The two groups of patients were given umbilical vein injection of methotrexate and oral mifepristone treatment,while patients in the short course group were treated for 1 weeks,and the patients in the long course group were treated for 4 weeks.The clinical efficacy,the recovery time of each index and incidence of adverse reactions in the two groups were compared.Results:The cure rate of the two groups was 100%.In the long course group,the conversion time ofβ-human chorionic gonadotropin(β-HCG)negative,creatine kinase(CK)negative,creatine kinase isoenzyme(CK-MB)negative and progesterone negative was significantly lower than that of the short course group(P<0.01).The time of placental complete removal,menstrual recovery and hospitalization in the long course group was all lower than that in the short course group(P<0.01),and the difference in treatment cost and incidence of adverse reactions between the two groups was not statistically significant(P>0.05).Conclusion:Increasing the administration time of methotrexate and mifepristone can not only improve the therapeutic effect of placenta implantation,but also will not increase the adverse reactions and treatment costs.The treatment is safe and worthy of clinical promotion.