局部注射甲氨蝶呤治疗不同超声表现剖宫产切口妊娠疗效初探

Study on efficacy of cesarean scar pregnancy with different ultrasound manifestationss by lesion injection methotrexate

目的探讨超声引导下局部注射甲氨蝶呤(MTX)治疗不同超声表现的剖宫产术后子宫瘢痕妊娠(CSP)的疗效。方法选择2012年1月至2018年1月在上海中医药大学附属曙光医院确诊剖宫产后CSP患者49例,年龄23~42岁,平均年龄30.7岁;孕5~11周,平均孕周5.8周。根据超声表现,将剖宫产后CSP分为孕囊注射组(26例)和局部注射组(23例)。在超声引导下经腹部对孕囊注射组切口区孕囊进行抽液,注入MTX治疗,对局部注射组切口区混合性回声进行局部MTX注射治疗,比较两组治愈率,治疗后血人绒毛膜促性腺激素(HCG)下降及病灶体积变化情况。结果孕囊注射组治愈率为84.62%(22/26例),局部治疗组治愈率为69.57%(16/23例);两组比较,差异无统计学意义(P> 0.05)。比较两组治疗前及治疗后第3、7、14、28天血HCG变化情况,虽然各检测点,孕囊注射组血HCG下降幅度均快于局部注射组(P <0.05),但两组下降率差异无统计学意义(P> 0.05)。治疗前和治疗后第14天,两组病灶体积比较,差异有统计学意义(P <0.05);治疗后第7、28天差异无统计学意义(P> 0.05)。两组病灶体积都在治疗后第7天达高峰,后逐渐缩小,第14天局部注射组明显缩小。结论局部注射MTX对孕囊型及混合型CSP的治疗均是有效的,可以作为临床保守治疗CSP安全、可靠的方法。

Objective To explore the efficacy of cesarean scar pregnancy(CSP) with different ultrasound manifestations by ultrasound-guided injection methotrexate(MTX). Methods From January 2012 to January 2018, 49 CSP patients were enrolled,which aged 23-42 years old with mean age of 30.7 years old. Pregnancy was 5-11 weeks with mean gestational weeks of5.8 weeks. All of CSP were divided into gestational sac injection group(n = 26) and lesion injection group(n = 23). The MTX was injected into incision area under guidance of abdominal ultrasound in gestational sac injection group, and mixed echo in incision area of lesion injection group was treated with lesion MTX injection. The cure rate, decline blood human chorionic gonadotropin(HCG) and lesion volume changed after treatment between 2 groups were compared. Results The cure rate of gestational sac injection group was 84.62 %(22/26) and that of lesion injection group was 69.57 %(16/23), and there was no significant difference between 2 groups(P > 0.05). The changes of blood HCG before and after treatment on the 3 rd, 7 th, 14 th, 28 th day were compared, and decline blood HCG in gestational sac injection group were faster than that in lesion injection group(P < 0.05), but there was no significant difference in decline rate between 2 groups(P > 0.05). There was significant difference in lesion volume before and the 14 th days after treatment between 2 groups(P < 0.05), but there was no significant difference between the 7 th and 28 th day after treatment(P > 0.05). The lesion volume reached the peak on the 7 th day after treatment, and then gradually decreased in 2 groups. The lesion volume was significantly smaller on the 14 th day than before treatment in lesion injection group. Conclusion It is demonstrated that lesion injection of MTX is effective in treatment of CSP with different ultrasound manifestations, which is safe and reliable conservative method in clinic.