甲氨蝶呤妊娠囊内注射联合清宫术对子宫瘢痕处妊娠的疗效

Effect of gestational sac injection with Methotrexate plus complete curettage of uterine cavity in Cesarean scar pregnancy

目的:分析子宫瘢痕妊娠(CSP)临床以甲氨蝶呤、清宫术配合治疗的有效性。方法:取2016.1-2018.1期间50例CSP者为研究对象,按临床治疗小组不同分组,对照组共24例(米非司酮+B超引导下清宫术)、观察组共26例(甲氨蝶呤、清宫术配合治疗),分析两组疗效差异,观察患者治疗情况(住院时间、阴道出血时间、阴道出血量、转开腹或腹腔镜或阴式手术的例数),比较出院时患者血HCG下降率,统计两组不良反应发生情况。结果:观察组转开腹或腹腔镜或阴式手术发生率为3.85%低于对照组12.50%,P<0.05;观察组阴道出血量少于对照组,阴道出血时间短于对照组,P<0.05;观察组不良反应发生率为3.85%与对照组8.33%比较无差异,P>0.05;出院时观察组HCG下降率高于对照组,P<0.05。结论:本次CSP者临床采用囊内注射甲氨蝶呤、清宫术配合治疗,治疗中转开腹或腹腔镜或阴式手术少,患者阴道出血量少,阴道出血时间短,不良反应发生率低。

Objective:To study the effectiveness of gestational sac injection with Methotrexate and complete curettage of uterine cavity in Cesarean scar pregnancy(CSP).Methods:50 CSP patients treated from January 2016 to January 2018 were selected and assigned to control group(n=24) and observation group(n=26) according to the different therapies. The control group was treated with complete curettage of uterine cavity;the observation group was treated with Methotrexate plus complete curettage of uterine cavity. The curative effect, operation conditions(intraoperative blood loss, hospitalization time, vaginal bleeding time) as well as postoperative recovery conditions(menstrual recovery time, disappearance time of enclosed mass and recovery time of β-HCG) after 3 m was analyzed.Results:The intraoperative blood loss, hospitalization time and vaginal bleeding time in the observation group were reduced, with statistically significant difference(P<0.05);the menstrual recovery time, disappearance time of enclosed mass and recovery time of β-HCG(β-human chorionic gonadotrophin) in the observation group was shorter than control group(P<0.05);the effective rate in the observation group(88.46%) was higher than control group(70.83%)(P<0.05).Conclusion:The combined mode of gestational sac injection with Methotrexate and complete curettage of uterine cavity can increase the curative effect, reduce the intraoperative blood loss, and shorten the menstrual recovery time, disappearance time of enclosed mass, hospitalization time and vaginal bleeding time.