清宫术前使用米非司酮治疗子宫瘢痕妊娠的临床效果及安全性分析

Analysis of clinical effect and safety of mifepristone in the treatment of uterine scar pregnancy before uterine curettage

目的:探讨清宫术前使用米非司酮治疗子宫瘢痕妊娠的临床效果及安全性。方法:选择2015年7月至2018年4月在十堰市人民医院诊治的子宫瘢痕妊娠患者78例作为研究对象,根据随机数字表法分为对照组40例与观察组38例,对照组给予常规清宫术治疗,观察组在对照组治疗的基础上在术前使用米非司酮治疗,记录2组患者预后效果与安全性。结果:2组患者手术时间、术中出血量差异无统计学意义(P>0.05),观察组的阴道出血时间、住院时间[(5.22±1.24)d和(11.67±3.13)d]显著少于对照组[(8.68±1.33)d和(14.22±2.82)d](P<0.05)。观察组术后30d的总有效率为100.0%,显著高于对照组的87.5%(P<0.05)。2组患者术前3d血清人绒毛膜促性腺激素(β-human chorionic gonadotrophin,β-HCG)水平差异无统计学意义(P>0.05),观察组术后1d与术后30 d的血清β-HCG水平[(1122±1111)mIU·mL-1和(7.13±10.62)mIU·mL-1]显著低于对照组[(2483±724)mIU·mL-1和(34.33±11.44)mIU·mL-1](P<0.05)。观察组术后30 d的膀胱损伤、感染、病灶残留等发生率为2.6%,显著低于对照组的17.5%(P<0.05)。结论:清宫术前使用米非司酮能够提高治疗子宫瘢痕妊娠的临床效果及安全性,促进血清β-HCG水平下降,从而促进患者康复。

Objective:To investigate the clinical effect and safety of mifepristone in the treatment of uterine scar pregnancy before uterine curettage.Methods:From July 2015 to April 2018,78 patients with uterine scar pregnancy who were treated in Shiyan Renmin Hospital were selected and were divided into the 40 patients in the control group and 38 patients in the observation group accorded to the random number table.The patients in the control group were treated with routine uterine curettage,the observation group were treated with preoperative mifepristone on the basis of the control group.The prognosis and safety of the two groups were recorded.Results:There were no significant difference in the operation time and intraoperative blood loss compared between the two groups(P>0.05).The vaginal bleeding time and hospital stay time in the observation group[(5.22±1.24)d and(11.67±3.13)d]were significantly lower than those in the control group[(8.68±1.33)d and(14.22±2.82)d](P<0.05).There were no significant difference in serumβ-human chorionic gonadotrophin(β-HCG)levels compared between the two groups in preoperative 3 days(P>0.05).The posteroperative 1 day and 30 days level of serumβ-HCG in the observation group[(1122±1111)mIU·mL-1 and(7.13±10.62)mIU·mL-1]were significantly lower than that in the control group[(2483±724)mIU·mL-1and(34.33±11.44)mIU·mL-1](P<0.05).The posteroperative 30 days of total effective rates of the observation group were 100.0%,which were significantly higher than that of the control group(87.5%)(P<0.05).The posteroperative 30 days of incidences such as bladder injury,infection and residual lesions in the observation group were 2.6%,which were significantly lower than that of the control group(17.5%)(P<0.05).Conclusion:Preoperative mifepristone can improve the clinical efficacy and safety in the treatment of uterine scar pregnancy,and promote the continuous decline of serumβ-HCG level,thus promote the recovery of patients.