妊娠囊内注射甲氨蝶呤联合宫腔镜下清宫术治疗Ⅱ型-Ⅲ型剖宫产瘢痕部位妊娠效果及安全性

Effect and safety of intrathecal injection of methotrexate combined with hysteroscopic curettage in the treatment of type Ⅱ-Ⅲ cesarean scar pregnancy

目的:探讨超声引导下妊娠囊内注射甲氨蝶呤联合宫腔镜下清宫术治疗治疗Ⅱ型-Ⅲ型剖宫产瘢痕部位妊娠(CSP)临床效果及安全性.方法:选取2019年1月~2022年2月我院收治的CSP患者66例为研究对象,采用随机数字表法将患者分为对照组(33例)和观察组(33例).对照组采用单纯宫腔镜下清宫术治疗,观察组采用超声引导下妊娠囊内注射甲氨蝶呤联合宫腔镜下清宫术治疗.比较两组临床疗效、术中情况、术后随访情况及并发症发生率.结果:观察组总有效率为96.97%,对照组为93.94%,差异无统计学意义.观察组术中出血量、术后大出血发生率、术后阴道流血时间显著低于或少于对照组,观察组术后血β-HCG恢复正常时间、包块消失时间、月经恢复正常时间均早于对照组,观察组并发症发生率低于对照组.结论:超声引导下妊娠囊内注射甲氨蝶呤联合宫腔镜下清宫术与单纯宫腔镜下清宫术治疗CSP相比,两者手术效果相当,但妊娠囊内注射甲氨蝶呤联合宫腔镜下清宫术术中出血少、术后恢复时间快,并发症少,手术更加安全可靠.

Objective To investigate the effect and safety of ultrasound-guided intrathecal injection of methotrexate combined with hysteroscopic curettage in the treatment of type Ⅱ-Ⅲ cesarean scar pregnancy(CSP).Methods 66 patients with CSP treated in my Hospital from January 2019 to February 2022 were selected as the research objects.The patients were randomly divided into control group(33 cases)and observation group(33 cases).The control group was treated with hysteroscopic curettage,and the observation group was treated with ultrasound-guided intrathecal injection of methotrexate combined with hysteroscopic curettage.The clinical efficacy,intraoperative condition,postoperative follow-up and complication rate were compared between the two groups.Results The total effective rate was 96.97%in the observation group and 93.94%in the control group.There was no significant difference.The amount of intraoperative bleeding,the incidence of massive bleeding and the time of postoperative vaginal bleeding in the observation group were significantly lower than or less than those in the control group The recovery time of/3-HCG and menstruation were earlier than that of the control group.The incidence of complications in the observation group(0.00%)was lower than that in the control group(12.12%).Conclusion Ultrasound guided intrathecal injection of methotrexate combined with hysteroscopic curettage has the same effect in the treatment of CSP compared with simple hysteroscopic curettage.However,intrathecal injection of methotrexate combined with hysteroscopic curettage has less bleeding,faster postoperative recovery time,fewer complications,and the operation is more safe and effective.