米非司酮用于瘢痕妊娠清宫术后的效果分析

Analysis of the effect of mifepristone for treating patients after curettage of scar pregnancy

目的:探讨米非司酮用于瘢痕妊娠清宫术后的效果。方法:2018年1月-2021年10月于本院行子宫瘢痕妊娠清宫术后1周血hCG>500U/L者共166例,其中直接清宫术后应用米非司酮组57例(直接观察组),不用米非司酮51例(直接对照组);介入治疗清宫术后应用米非司酮25例(介入观察组),不用米非司酮33例(介入对照组)。分别比较用药组与对照组的临床效果。结果:直接清宫术后4周血hCG[M(P25,P75)]观察组28.00(13.25,57.25)U/L,对照组57.00(28.00,122.60)U/L;术后6周hCG观察组4.22(0.10,8.66)U/L,对照组13.00(5.50,31.40)U/L;血hCG恢复正常时间观察组(39.0±8.9)d,对照组(48.8±10.6)d;月经复潮的时间观察组(39.4±9.4)d,对照组(49.4±14.6)d;切口团块消失时间用药组(48.7±13.8)d,对照组(55.4±14.7)d;随诊复查次数观察组5(5,6)次,对照组7(7,8)次。直接清宫术两组比较均有差异(P<0.05)。介入治疗后清宫术两组比较上述指标均无差异(P>0.05)。结论:米非司酮用于治疗直接清宫术血hCG下降不满意或瘢痕处团块吸收欠佳,可以加快血hCG恢复正常的时间,促进月经复潮及切口团块的消失,减少术后随访的次数。

Objective:To explore the effect of mifepristone for treating patients after curettage of scar pregnancy.Methods:From January 2018 to October 2021,166 patients with HCG level>500U/L in 1 week after uterine curettage of scar pregnancy were included in this study.Among them,there were 57 cases with mifepristone treatment after direct curettage in group A,51 cases without mifepristone treatment after direct curettage in group B,25 cases with mifepristone treatment after interventional therapy and curettage in group C,and 33 cases without mifepristone treatment after interventional therapy and curettage in group D.The clinical effects of the patients were compared between group A and group B,and between group C and group D.Results:There were significant differences in the blood human chorionic gonadotropin(hCG)levels in the 4th week after direct uterine curettage 28.00(13.25,57.25)U/L vs.57.00(28.00,122.60)U/L and in the 6th week after direct uterine curettage 4.22(0.10,8.66)U/L vs.13.00(5.50,31.40)U/L of the patients between group A and group B(P<0.05).There were significant differences in the time of blood hCG returning to normal(39.0±8.9 d vs.48.8±10.6 d),the time of menstruation recovery(39.4±9.4 vs.49.4±14.6 d),the disappearance time of incision mass(48.7±13.8 d vs.55.4±14.7 d),and the review times during follow-up(5(5,6)times vs.7(7,8)times)of the patients between group A and group B(P<0.05).There were no significant differences in the blood hCG levels in the 4th week after direct uterine curettage and in the 6th week after direct uterine curettage of the patients between group C and group D(P>0.05).There were no significant differences in the time of blood hCG returning to normal,the time of menstruation recovery,the disappearance time of incision mass,and the review times during follow-up of the patients between group C and group D(P>0.05).Conclusion:Mifepristone used to treating the patients with unsatisfied decrease of serum hCG level or poor absorption of scar mass after direct uterine curettage can speed up their serum hCG level returning to normal,can promote the recovery of their menstruation and the disappearance of their incision mass,and can reduce the number of their postoperative follow-up.