B超引导下宫腔镜电切术联合甲氨蝶呤治疗子宫切口瘢痕妊娠的可行性分析

Feasibility Analysis of B-ultrasound Guided Hysteroscopic Resection Combined with Methotrexate in the Treatment of Uterine Incision Scar Pregnancy

目的探讨B超引导下宫腔镜电切术联合甲氨蝶呤治疗子宫切口瘢痕妊娠患者的可行性。方法按照随机数字表法将2016年1月~2018年12月我院接受治疗的80例切口瘢痕妊娠患者分为两组,每组40例。对照组行甲氨蝶呤联合负压吸引清宫术治疗,研究组行B超引导下宫腔镜电切术与甲氨蝶呤治疗,比较两组治疗情况、预后及术后并发症情况。结果研究组手术时间、术后阴道流血时间、住院时间、月经周期恢复时间、血β-hCG水平恢复时间均短于对照组(P<0.05);研究组的术中出血量为(33.00±7.01)ml,少于对照组的(83.00±7.98)ml(P<0.05);研究组随访1年内妊娠率和顺产率为82.50%、67.50%,高于对照组的35.00%和37.50%;剖宫产率为5.00%,低于对照组的40.00%(P<0.05);研究组术后并发症率为2.50%,低于对照组的25.00%(P<0.05)。结论B超引导下宫腔镜电切术与甲氨蝶呤治疗切口瘢痕妊娠,治疗效果确切,有助于提高妊娠率与顺产率,降低剖宫产率,减少术后并发症的发生。

Objective To investigate the feasibility of B-ultrasound guided hysteroscopic resection combined with methotrexate in the treatment of uterine incision scar pregnancy patients.Methods According to the random number table method,80 patients with incision scar pregnancy who received treatment in our hospital from January 2016 to December 2018 were divided into two groups,each with 40 cases.The control group underwent methotrexate combined with negative pressure suction uterine evacuation treatment,and the study group underwent B-ultrasound guided hysteroscopy and methotrexate treatment.The treatment,prognosis and postoperative complications of the two groups were compared.Results The operation time,postoperative vaginal bleeding time,hospitalization time,menstrual cycle recovery time,and bloodβ-hCG level recovery time in the study group were shorter than those in the control group(P<0.05);The intraoperative blood loss in the study group was(33.00±7.01)ml,which was less than(83.00±7.98)ml in the control group(P<0.05);The pregnancy rate and delivery rate within 1 year of the study group were 82.50%and 67.50%,which were higher than 35.00%and 37.50%of the control group;the cesarean section rate was 5.00%,which was lower than 40.00%of the control group(P<0.05);The postoperative complication rate in the study group was 2.50%,which was lower than the 25.00%in the control group(P<0.05).Conclusion B-ultrasound guided hysteroscopic resection and methotrexate in the treatment of incision scar pregnancy have a definite therapeutic effect,which is helpful to increase pregnancy rate and cistern birth rate,reduce cesarean section rate,and reduce postoperative complications.