剖宫产瘢痕妊娠43例人工流产的临床观察与思考

Clinical Investigation of Artificial Abortion in 43 Cases With Cesarean Scar Pregnancy

目的探讨术前甲氨蝶呤联合B超监视下行宫腔镜清宫术在剖宫产瘢痕妊娠患者中的应用效果。方法回顾性分析2012年5月—2017年5月西安曲江妇产医院收治的43例剖宫产瘢痕妊娠患者进行研究,随机分为观察组(n=23)与对照组(n=20)。对照组给予B超监视下行宫腔镜清宫术治疗,观察组给予甲氨蝶呤联合B超监视下行宫腔镜清宫术治疗。比较两组患者的疗效、术中出血量、血β-HCG恢复时间、月经周期恢复时间及不良反应。结果治疗后,观察组的总有效率明显高于对照组,术中出血量明显低于对照组,血β-HCG恢复时间、月经周期恢复时间明显短于对照组,比较其差异有统计学意义(P<0.05)。两组的不良反应发生率比较差异无统计学意义(P>0.05)。结论B超监视下行宫腔镜清宫术联合术前甲氨蝶呤治疗剖宫产瘢痕妊娠患者的疗效显著,可降低患者术中出血量,明显缩短患者的恢复时间,且安全性较高,值得在临床上应用。

Objective To investigate the effect of preoperative methotrexate combined with B-ultrasound on hysteroscopic uterine surgery in patients with cesarean scar pregnancy.Methods In this study,a retrospective analysis of 43 patients with cesarean scar pregnancy admitted to Xi'an Qujiang Maternity Hospital from May 2012 to May 2017 was randomLy divided into observation group(n=23)and control group(n=20).The control group was treated with B-ultrasound and hysteroscopic surgery.The observation group was treated with methotrexate combined with B-ultrasound and hysteroscopic surgery.The efficacy,intraoperative blood loss,bloodβ-HCG recovery time,menstrual cycle recovery time and adverse reactions between the two groups were compared.Results After treatment,the total effective rate of the observation group was significantly higher than that of the control group.The intraoperative blood loss was significantly lower than that of the control group.The bloodβ-HCG recovery time and menstrual cycle recovery time were significantly shorter than the control group,and there was significant difference(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion B-ultrasound combined with hysteroscopic uterine hysterectomy combined with preoperative methotrexate in the treatment of cesarean scar pregnancy patients can significantly reduce the amount of intraoperative blood loss,significantly shorten the recovery time of patients,and the safety is higher,worthy of Clinically applied.