超声引导下甲氨喋呤给药辅助宫腔镜治疗剖宫产瘢痕妊娠的临床效果分析

Clinical effect of ultrasound-guided methotrexate administration assisted hysteroscopy in the treatment of cesarean scar pregnancy

目的探讨超声引导下甲氨喋呤(methotrexate,MTX)囊内注射结合宫腔镜手术治疗剖宫产瘢痕妊娠的临床效果。方法选取2016年9月至2018年10月昆山市第四人民医院收治的80例剖宫产瘢痕妊娠患者,采用随机数字表法分为研究组和对照组,各40例。研究组采用MTX囊内注射结合宫腔镜手术治疗,对照组采用MTX肌肉注射结合宫腔镜手术治疗。观察两组的MTX使用剂量、手术时间、术中出血量、β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-h CG)转阴时间、住院时间、月经恢复时间、月经周期、术前及术后3月的卵巢内分泌功能。结果研究组患者的MTX使用剂量、手术时间、术中出血量、β-h CG转阴时间、住院时间、月经恢复时间均低于对照组,差异有统计学意义(P<0.05);两组月经周期时间比较差异无统计学意义(P>0.05);术前及术后3个月,研究组和对照组孕酮、促卵泡激素、促黄体生成素、雌二醇水平比较,差异均无统计学意义(P>0.05);研究组患者不良反应发生率(7.50%)低于对照组(27.50%),差异有统计学意义(P<0.05)。结论超声引导下MTX囊内注射结合宫腔镜手术治疗剖宫产瘢痕妊娠的临床效果优于MTX肌肉注射结合宫腔镜手术。

Objective To investigate the clinical effect of ultrasound-guided intramyocardial injection of methotrexate( MTX) combined with hysteroscopic surgery for cesarean section scar pregnancy. Methods Eighty patients with cesarean section scar pregnancy admitted to Kunshan Fourth People’s Hospital from September 2016 to October 2018 were divided into the study group and the control group by random number table,each with 40 patients. The study group was treated with MTX intracapsular injection combined with hysteroscopic surgery. The control group was treated with MTX intramuscular injection combined with hysteroscopic surgery.Observed the dose of MTX,operation time,intraoperative blood loss,β-human chorionic gonadotropin( β-h CG) negative time,hospital stay,menstrual recovery time,menstrual cycle,ovarian endocrine function before and 3 months after surgery. Results The MTX dose,operation time,intraoperative blood loss,β-h CG negative time,hospital stay,and menstrual recovery time were lower in the study group than in the control group,and the differences were statistically significant( P < 0. 05). There was no difference in menstrual cycle time between the two groups( P > 0. 05). There were no significant differences in the levels of progesterone,follicle stimulating hormone,luteinizing hormone,and estradiol between the study group and the control group before and 3 months after the operation( P > 0. 05). The incidence of adverse reactions was 7. 50 % lower in the study group than that of the control group( 27. 50 %)( P <0. 05). Conclusion Ultrasound-guided intramyocardial injection of MTX combined with hysteroscopic surgery for cesarean section scar pregnancy is superior to MTX intramuscular injection combined with hysteroscopic surgery.