甲氨喋呤联合宫腔镜治疗内生型剖宫产瘢痕妊娠效果

The clinical efficacy of methotrexate combined with hysteroscopy for treating women with endogenous cesarean scar pregnancy

目的:分析甲氨喋呤(MTX)联合宫腔镜治疗内生型剖宫产瘢痕妊娠(CSP)临床疗效。方法:选择2011年1月-2015年12月本院诊治的CSP患者72例,按照自愿选择原则分两组,分别应用MTX联合清宫术治疗(清宫组)或MTX联合宫腔镜治疗(宫腔镜组),比较两组及宫腔镜组中不同病灶大小者临床疗效。结果:总有效率宫腔镜组(97.4%)高于清宫组(84.9%)(P=0.020),术中出血量(72.0±11.6ml)、血β-hCG降至正常时间(20.1±8.0d)、术后住院时间(11.6±3.3d)均低于清宫组(P=0.000、0.002、0.010)。宫腔镜组中病灶直径≤2.5cm患者治疗总有效率(100%)高于病灶直径>2.5cm患者(90.9%)(P=0.010)。结论:MTX联合宫腔镜对于内生型瘢痕妊娠,尤其是对于病灶直径≤2.5cm的病例有较好疗效,降低术中大出血发生几率,利于术后恢复。

Objective:To analyze the clinical efficacy of methotrexate(MTX)combined with hysteroscopy for treating women with endogenous cesarean scar pregnancy(CSP).Methods:72 women with endogenous CSP were selected and were divided into control group and observation group according to the principles of voluntary selection.The women in the control group were given the treatment of methotrexate combined with curettage,and the women in the observation were given the treatment of methotrexate combined with hysteroscopy.The clinical curative effect of the women was compared between the two groups,and the clinical curative effect was also compared among the women with different size of the lesions.Results:The total effective rate(97.4%)of the women in the observation group was significant higher than that(84.9%)of the women in the control group(P=0.020).The intraoperative blood loss(72.0±11.6ml),the time of bloodβ-hCG level returned to normal(20.1±8.0d),and the time of postoperative hospital stay(11.6±3.3d)of the women in the observation group were significant lower than those of the women in the control group(P=0.000,0.002,and 0.010).In the observation group,the total effective rate(100%)of the women with lesion diameter≤2.5cm was significant higher than that(90.9%)of the women with lesion diameter>2.5cm(P=0.010).Conclusion:The methotrexate combined with hysteroscopy for treating endogenous CSP has good curative effectiveness,especially for those women with lesion diameter≤2.5cm,which can reduce intraoperative massive haemorrhage occurrence and is beneficial to postoperative recovery.