超声介入下聚多卡醇配合甲氨蝶呤局部注射治疗剖宫产子宫瘢痕妊娠的临床疗效研究

Study on the Clinical efficacy of Local Injection of Polidocanol Combined with Methotrexate in the Treatment of Uterine Scar Pregnancy after Cesarean Section un⁃der Ultrasound Intervention

目的探讨剖宫产子宫瘢痕妊娠患者在超声介入下使用聚多卡醇配合甲氨蝶呤局部注射治疗在临床应用的疗效。方法选取2020年9月—2022年10月临沂市中心医院就诊的60例剖宫产子宫瘢痕妊娠(cesarean scar pregnancy,CSP)患者,使用随机数表法将患者分为对照组(30例)和观察组(30例),观察组使用超声介入下聚多卡醇配合甲氨蝶呤局部注射治疗,对照组使用双侧子宫动脉栓塞术治疗,对比两组患者的手术相关指标、住院时间、术后不良反应发生率及卵巢激素水平变化。结果两组术中出血量、住院时间和β-绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)恢复正常时间对比,差异无统计学意义(P>0.05);观察组手术后月经和排卵恢复正常的时间均短于对照组,差异有统计学意义(P<0.05)。观察组术后不良反应率为6.67%明显低于对照组的26.67%,差异有统计学意义(χ^(2)=4.320,P<0.05)。观察组术后促卵泡刺激素(Follicle-Stimulating Hormone,FSH)、雌二醇(estradiol,E2)水平均低于对照组,促黄体生成素(luteinizing hormone,LH)水平高于对照组,差异有统计学意义(P<0.05)。结论剖宫产子宫瘢痕妊娠患者在超声介入下使用聚多卡醇配合甲氨蝶呤局部注射治疗效果明确,可促进患者月经及排卵功能的恢复,且具有安全性。

Objective To explore the clinical efficacy of polidocanol combined with local injection of methotrexate under ultrasound intervention in patients with uterine scar pregnancy after cesarean section.Methods 60 patients with cesarean scar pregnancy(CSP)who received treatment in Linyi Central Hospital from September 2020 to October 2022 were selected and divided into control group(30 cases)and observation group(30 cases)by random number table method.The observation group was treated with local injection of polydocaol combined with methotrexate under ultrasound intervention,while the control group was treated with bilateral uterine artery embolization.The operation-related indexes,length of hospital stay,incidence of postoperative adverse reactions and changes in ovarian hormone levels of the two groups were compared.Results There was no significant difference in the amount of blood loss,length of hospital stay and the time to return to normal ofβ-human chorionic gonadotropin(β-HCG)between the two groups(P>0.05).The recovery time of menstruation and ovulation in the observation group was shorter than that in the control group,and the difference was statistically significant(P<0.05).The rate of postoperative adverse reactions in the observation group(6.67%)was significantly lower than that in the control group(26.67%),and the difference was statistically significant(2=4.32,P<0.05).Follicle-Stimulating Hormone(FSH)and estradiol(E2)levels in the observation group were lower than those in the control group,and luteinizing hormone(LH)levels were higher,and the difference was statistically significant(P<0.05).Conclusion The use of polidocanol combined with local injection of methotrexate under ultrasound intervention has a clear therapeutic effect on patients with uterine scar pregnancy after cesarean section.It can promote the recovery of menstrual and ovulatory functions,is safe,and is worthy of clinical promotion and application.