米非司酮联合双侧子宫动脉灌注甲氨蝶呤治疗剖宫产瘢痕妊娠临床评价

Efficacy Evaluation of Mifepristone Combined with Bilateral Uterine Artery Infusion of Methotrexate in the Treatment of Patients with Cesarean Scar Pregnancy

目的研究米非司酮联合双侧子宫动脉灌注甲氨蝶呤(MTX)治疗剖宫产瘢痕妊娠(CSP)的临床疗效,以及对血β-人绒毛膜促性腺激素(β-HCG)水平的影响。方法选取秦皇岛军工医院2018年1月至2019年1月收治的CSP患者74例,按随机数字表法分为对照组和治疗组,各37例。两组患者均口服米非司酮片,并超声引导下清宫,治疗组患者加用双侧子宫动脉灌注MTX。结果治疗组有效率为91.89%,显著高于对照组的67.57%(P <0.05);治疗组患者清宫术时间、β-HCG转阴时间、孕囊消失时间、月经恢复时间和住院时间均显著短于对照组(P <0.05);治疗组患者术后的β-HCG水平显著低于对照组,孕酮、雌二醇、黄体生成素、卵泡刺激素水平均显著高于对照组(P <0.05);治疗组不良反应发生率为5.41%,显著低于对照组的24.32%(P <0.05)。结论米非司酮联合双侧子宫动脉灌注MTX治疗CSP,可缩短清宫术时间和β-HCG转阴时间,改善β-HCG水平,且对性激素水平无明显不良影响。

Objective To study the clinical efficacy of mifepristone combined with bilateral uterine artery infusion of methotrexate(MTX)in the treatment of patients with cesarean scar pregnancy(CSP),and the effect on the level of serum human chorionic gonadotropinβ(β-HCG).Methods A total of 74 patients with CSP admitted to the Qinhuangdao Military Hospital were selected and divided into the control group and the treatment group according to the random number table method,37 cases in each group.The patients in the two groups were given the oral treatment of Mifepristone Tablets and ultrasound-guided uterine clearance,on this basis,the patients in the treatment group were treated with bilateral uterine artery perfusion of MTX.Results The effective rate of the treatment group was91.89%,which was significantly higher than 67.57%of the control group(P<0.05).The time of curettage,the time ofβ-HCG turning negative,the time of gestational sac disappearing,the time of menstrual recovery and the length of stay in the treatment group were significantly shorter than those in the control group(P<0.05).The level ofβ-HCG in the treatment group was significantly lower than that in the control group,while the levels of progesterone,estradiol,luteinizing hormone and follicle-stimulating hormone in the treatment group were significantly higher than those in the control group(P<0.05).The incidence of adverse reactions in the treatment group was 5.41%,which was significantly lower than 24.32%in the control group(P<0.05).Conclusion Mifepristone combined with bilateral uterine artery infusion of MTX in the treatment of patients with CSP can shorten the time of curettage andβ-HCG turning negative,improve the level ofβ-HCG,and has no obvious adverse effect on the level of sex hormone.