甲氨喋呤预处理联合手术治疗非破裂子宫瘢痕妊娠患者的临床价值

Clinical value of methotrexate pretreatment combined with surgery for non-ruptured uterine scar pregnancy

目的探讨甲氨喋呤预处理联合手术治疗非破裂子宫瘢痕妊娠患者的临床效果。方法选择2018年1月~2019年12月治疗的非破裂子宫瘢痕妊娠患者90例,按随机数字表法分为两组,其中对照组45例采用肌肉注射甲氨蝶呤+口服米非司酮+清宫术治疗,观察组45例采用动脉栓塞+子宫动脉灌注甲氨蝶呤+清宫术治疗,比较两组患者清宫术的时间间隔、手术时间及成功率、术中出血量、住院时间、治疗费用以及随访3个月时患者的恢复情况。结果两组患者的手术成功率比较,观察组(100.00%)显著高于对照组(84.44%),差异有统计学意义(P<0.05)。观察组清宫术的时间间隔及手术时间、术中出血量、住院时间、治疗费用均低于对照组,组间差异有统计学意义(均P<0.05)。两组患者随访3个月时的恢复情况比较,观察组患者月经恢复正常时间、阴道流血时间及血清β-人绒毛膜促性腺激素(β-HCG)降至正常时间均优于对照组,差异均有统计学意义(均P<0.05)。结论甲氨喋呤预处理联合手术治疗非破裂子宫瘢痕妊娠的效果良好,患者术后恢复快,住院时间短,治疗费用低,值得临床应用。

Objective To investigate the clinical effect of methotrexate pretreatment combined with surgery in the treatment of non-ruptured uterine scar pregnancy.Methods From January 2018 to December 2019,for the treatment of 90 patients with uterine scar pregnancy not burst,according to random number table method is divided into two groups,control group 45 cases treat with intramuscular injection of methotrexate+oral mifepristone+complete curettage of uterine cavity,observation group 45 cases treat with arterial embolization+uterine artery infusion for the treatment of methotrexate+complete curettage of uterine cavity.The time interval,operation time and success rate,intraoperative blood loss,length of hospital stay,treatment cost and the recovery of patients at 3 months follow-up were compared between the two groups.Results The success rate of the two groups of patients was significantly higher in the observation group(100.00%)than in the control group(84.44%),the difference was statistically significant(P<0.05).The time interval of hysterectomy,operation time,intraoperative blood loss,hospital stay and treatment cost in the observation group were lower than those in the control group,and the differences between groups were statistically significant(all P<0.05).The recovery of 2 groups after 3 months follow-up was compared,the menstrual recovery time,vaginal bleeding time and serumβ-human chorionic gonadotropin(β-hCG)decreased to normal time in the observation group were better than those in the control group,the differences were statistically significant(P<0.05 for all).Conclusion Methotrexate pretreatment combined with surgery in the treatment of non-ruptured uterine scar pregnancy has a good effect,quick postoperative recovery,short hospitalization time and low treatment cost,which is worthy of clinical application.