甲氨蝶呤联合宫腔镜清宫术治疗剖宫产瘢痕妊娠的临床效果

Clinical Effect of Methotrexate Combined with Hysteroscopic Curettage in the Treatment of Cesarean Scar Pregnancy

目的:分析甲氨蝶呤联合宫腔镜清宫术治疗剖宫产瘢痕妊娠的临床效果。方法:选取2021年4月—2023年4月贵阳市花溪区中医院收治的剖宫产瘢痕妊娠患者68例作为研究对象,运用随机分组法分为对照组和观察组,各34例。对照组采用宫腔镜清宫术,观察组采用甲氨蝶呤联合宫腔镜清宫术。比较两组临床指标、卵巢功能、应激因子、不良反应。结果:观察组术中出血量少于对照组,大出血发生率低于对照组,术后阴道流血时间、血人绒毛膜促性腺激素水平恢复正常时间、包块消失时间、月经恢复正常时间、住院时间短于对照组,差异有统计学意义(P<0.001);治疗后,观察组促卵泡激素、促黄体生成素水平低于对照组,雌二醇水平高于对照组,差异有统计学意义(P<0.001);治疗后,两组肌酸激酶、肌酸激酶同工酶、血管内皮生长因子、妊娠相关血浆蛋白A、转化生长因子β1水平低于治疗前,观察组低于对照组,差异有统计学意义(P<0.001)。结论:甲氨蝶呤联合宫腔镜清宫术治疗剖宫产瘢痕妊娠效果显著,能够控制术中出血量,改善卵巢功能及应激因子水平,促进术后恢复,安全性高。

Objective:To analyze the clinical effect of methotrexate combined with hysteroscopic curettage in the treatment of cesarean scar pregnancy.Methods:Sixty-eight patients with cesarean scar pregnancy admitted to Guiyang Huaxi District Hospital of Traditional Chinese Medicine from April 2021 to April 2023 were selected as the study objects,and were divided into control group and observation group by random grouping method,with thirty-four cases in each group.The control group was treated with hysteroscopic curettage,and the observation group was treated with methotrexate combined with hysteroscopic curettage.Clinical indexes,ovarian function,stress factors and adverse reactions were compared between the two groups.Results:The amount of intraoperative bleeding in the observation group was less than that in the control group,and the incidence of major bleeding was lower than that in the control group,postoperative vaginal bleeding time,blood human chorionic gonadotropin level return to normal time,mass disappearance time,menstruation return to normal time,hospitalization time were shorter than control group,the difference was statistically significant(P<0.001);after treatment,the levels of follicle-stimulating hormone and luteinizing hormone in observation group were lower than those in control group,and the level of estradiol was higher than that in control group,the difference was statistically significant(P<0.001);after treatment,the levels of creatine kinase,creatine kinase isoenzyme,vascular endothelial growth factor,pregnance-related plasma protein A and transforming growth factorβ1 in two groups were lower than before treatment,and the observation group was lower than the control group,the difference was statistically significant(P<0.001).Conclusion:Methotrexate combined with hysteroscopic curettage has a significant effect in the treatment of caesarean section scar pregnancy,which can control intraoperative blood loss,improve ovarian function and stress factor levels,and promote postoperative recovery with high safety.