甲氨蝶呤联合宫腔镜手术治疗剖宫产术后子宫瘢痕妊娠的疗效分析

Analysis of the Curative Effect of Methotrexate Combined with Hysteroscopy in the Treatment of Uterine Scar Pregnancy after Cesarean Section

目的探究剖宫产术后子宫瘢痕妊娠(CSP)应用甲氨蝶呤(MTX)联合宫腔镜手术治疗的效果。方法方便选取2017年1月—2019年12月该院收治的52例CSP患者进行研究,按随机排列法分为对照组26例,予MTX肌内注射5~7 d后行清宫术治疗;研究组26例,予MTX肌内注射5~7 d后行宫腔镜下妊娠病灶清除术治疗。以治疗时间、出血量、住院时间,β-hCG水平恢复正常时间、包块消失时间、月经复潮时间,术前、术后24、48、72 h疼痛(VAS)评分,终止妊娠成功率完成对治疗情况、治疗时间指标、手术前后疼痛情况、治疗结局的评价。结果研究组治疗时间、住院时间短于对照组,且出血量少于对照组,差异有统计学意义(P<0.05);研究组β-hCG水平恢复正常时间、宫腔包块消失时间、月经复潮时间均短于对照组,差异有统计学意义(P<0.05);术前、术后24 h两组VAS评分对比差异无统计学意义(P>0.05);术后48、72 h,研究组VAS评分均低于对照组,差异有统计学意义(P<0.05);研究组终止妊娠成功率为88.46%,高于对照组61.54%,差异有统计学意义(χ^(2)=5.026,P<0.05)。结论MTX联合宫腔镜手术治疗CSP疗效确切,能够减轻对患者的创伤、减轻疼痛、缩短治疗治疗时间、促进术后患者的恢复,同时改善治疗结局。

Objective To explore the effect of methotrexate(MTX)combined with hysteroscopy in the treatment of uterine scar pregnancy(CSP)after cesarean section.Methods Fifty-two patients with CSP admitted to the hospital from January 2017 to December 2019 were conveniently selected in the study.According to the random arrangement,they were divided into 26 cases in the control group,which were injected with MTX intramuscularly for 5-7 days and then treated with uterine evacuation;26 cases in the study group were injected with MTX intramuscularly 5-7 days,the pregnancy lesions were treated with hysteroscopy.According to treatment time,blood loss,length of hospital stay,time forβ-hCG level to return to normal,time for mass disappearance,time for menstrual re-fluidity,pain(VAS)scores at 24 h,48 h,72 h before and after surgery,and the success rate of pregnancy termination completed the evaluation of treatment status,treatment time indicators,pain before and after surgery,and treatment outcome.Results The treatment time and hospital stay of the study group were shorter than those of the control group,and the bleeding volume was less than that of the control group.The difference was statistically significant(P<0.05);the time for theβ-hCG level of the study group to return to normal,the time for the disappearance of the uterine mass,and the time for menstrual renewal were shorter than the control group,the difference was statistically significant(P<0.05);there was no statistically significant difference in the VAS scores of the two groups before and after 24 h(P>0.05);48 h and 72 h after the operation,the VAS scores of the study group were lower than those of the control group.The difference was statistically significant(P<0.05);the success rate of pregnancy termination in the study group was 88.46%,which was higher than 61.54%in the control group,and the difference was statistically significant(χ^(2)=5.026,P<0.05).Conclusion MTX combined with hysteroscopic surgery is effective in treating CSP.It can reduce trauma,pain,shorten the treatment time,promote the recovery of patients after surgery,and improve the outcome of treatment.