超声引导下妊娠囊内注射甲氨蝶呤对剖宫产瘢痕妊娠治疗效果分析

The therapeutic effect of ultrasound-guided intrathecal injection of methotrexate on cesarean scar pregnancy

目的探讨经阴道超声介入引导下局部注射甲氨蝶呤(MTX)治疗剖宫产瘢痕妊娠(CSP)的临床疗效。方法选取就诊于河北省邯郸市中心医院的CSP患者87例,依随机数字表法随机分为3组:肌肉注射组(A组)29例、静脉注射组(B组)29例、超声介入组(C组)29例。全部病例治疗时先口服米非司酮,A组患者肌肉注射MTX,B组患者静脉注射MTX,C组患者在超声介入引导下局部注射MTX进行治疗,同时对3组患者后续采取清宫治疗,治疗后进行统计观察临床治疗效果、不良反应、治疗有效率。结果3组CSP患者平均清宫出血量、平均住院时间、血β-HCG恢复正常时间、月经恢复正常时间、术后排卵恢复时间、总治疗费用比较,除住院时间差异无统计学意义外,其他项比较C组数据优于A组和B组,两两比较差异均有统计学意义(P<0.05)。3组的不良反应发生率比较,C组患者的骨髓抑制、心悸、恶心、腹部疼痛等总不良反应发生率27.6%(8/29)低于A组75.9%(22/29)和B组55.2%(16/29),差异有统计学意义(χ^(2)=11.67,P=0.001和χ^(2)=4.55,P=0.033)。C组患者治疗的有效率高于A组和B组(P<0.05)。结论C组超声引导下经阴道穿刺抽液并注射MTX治疗CSP相比A组和B组具有不良反应小、安全性高、成功率高、疗效确切等优点,值得临床推广。

Objective To explore the clinical efficacy of local injection of methotrexate(MTX) under the guidance of transvaginal ultrasound intervention for the treatment of caesarean scar pregnancy(CSP).Methods Eighty-seven patients with CSP in Handan Central Hospital were randomly divided into 3 groups:intramuscular injection group(group A,n=29),intravenous injection group(group B,n=29),and ultrasound intervention group(group C,n=29).All cases were treated with oral mifepristone,patients in group A were intramuscularly injected with MTX,patients in group B were intravenously injected with MTX,and patients in group C were treated with local injection of MTX under the guidance of ultrasound intervention.Then the clinical treatment effect,adverse reactions,and treatment efficiency were observed.Results The average uterine bleeding volume,bloodβ-human chorionic gonadotropin(HCG)recovery time,menstrual recovery time,postoperative ovulation recovery time,and total treatment cost data of CSP patients in group C were generally better than those in group A and group B,the difference statistically significant(P<0.05).There was no significant difference in the length of hospitalization.As for the incidence of adverse reactions,the incidence of total adverse reactions such as bone marrow suppression,palpitations,nausea,and abdominal pain in group C[27.6%(8/29)]was significantly lower than that in groups A[75.9%(22/29)]and B[55.2%(16/29)],the difference was statistically significant(χ^(2)=11.67,P=0.001 and χ^(2)=4.55,P=0.033).The treatment efficiency of patients in group C was higher than that in groups A and B(P<0.05).Conclusion Compared with group A and group B,group C has fewer adverse reactions,higher safety,higher success rate,and definite efficacy.It is worthy of clinical promotion.