米非司酮联合甲氨蝶呤孕囊内注射对内生型剖宫产瘢痕妊娠的临床效果分析

Clinical effect of mifepristone combined with methotrexate intra-gestational sac injection on endogenous cesarean scar pregnancy

目的探讨米非司酮联合甲氨蝶呤孕囊内注射对内生型剖宫产瘢痕妊娠(CSP)的临床效果。方法选择金华市妇幼保健院2014年6月至2019年6月收治的内生型CSP患者106例为研究对象,按照随机数字表法分为对照组53例与观察组53例。对照组行宫腔镜下刮宫术,观察组在对照组基础上结合米非司酮联合甲氨蝶呤孕囊内注射。比较两组治疗疗效、血β-人绒毛膜促性腺激素(β-HCG)恢复正常时间、术中出血量及术后并发症和住院时间。结果观察组治疗总有效率[92.45%(49/53)]高于对照组[75.47%(40/53)],差异有统计学意义(χ^2=5.675,P<0.05)。观察组血β-HCG恢复正常时间[(17.58±2.54)d]快于对照组[(21.83±4.13)d],且术中出血量[(25.42±5.46)mL]少于对照组[(87.93±18.47)mL],差异均有统计学意义(t=6.381、23.628,均P<0.05)。观察组术后并发症[1.89%(1/53)]少于对照组[9.43(5/53)],差异无统计学意义(χ^2=1.590,P>0.05);观察组住院时间[(7.83±1.52)d]短于对照组[(9.68±2.19)d],差异有统计学意义(t=5.052,P<0.05)。结论米非司酮联合甲氨蝶呤孕囊内注射对内生型CSP患者临床效果良好,可加快血β-HCG恢复正常时间,值得临床借鉴。

Objective To explore the effect of mifepristone combined with methotrexate intracapsular injection on pregnancy at scar site of endogenous cesarean section.Methods From June 2014 to June 2019,106 cases of pregnancy at scar site of endogenous cesarean section admitted to Jinhua Maternal and Child Health Hospital were selected in the research.According to the random number table method,the patients were divided into control group and observation group,with 53 cases in each group.The control group received hysteroscopy curettage only,routine anti-infection,curettage under the guidance of B-ultrasound.The observation group was given mifepristone and methotrexate intracapsular injection on the basis of the control group.The clinical effect,recovery time of serumβ-HCG,intraoperative blood loss,postoperative complications and hospitalization time were compared between the two groups.Results The total effective rate of the observation group[92.45%(49/53)]was higher than that of the control group[75.47%(40/53)](χ^2=5.675,P<0.05).The recovery time ofβhuman chorionic gonadotropin(β-HCG)in the observation group[(17.58±2.54)d]was faster than that in the control group[(21.83±4.13)d],and the intraoperative blood loss[(25.42±5.46)mL]was less than that in the control group[(87.93±18.47)mL],the differences were statistically significant(t=6.381,23.628,all P<0.05).The incidence of postoperative complications of the observation group(1.89%)was lower than that of the control group(9.43%),but there was no statistically significant difference between the two groups(χ^2=1.590,P>0.05).The hospitalization time of the observation group[(7.83±1.52)d]was shorter than that of the control group[(9.68±2.19)d](t=5.052,P<0.05).Conclusion Mifepristone combined with methotrexate intracapsular injection has good clinical effect on endogenous cesarean scar pregnancy.It can accelerate the recovery time of bloodβ-HCG,which is worthy of clinical reference.