甲氨蝶呤、米非司酮联合化瘀消癥汤治疗子宫切口瘢痕部异位妊娠的临床观察

Observation on Clinical Efficacy and Safety of Methotrexate and Mifepristone Combined with Huayu Xiaozheng Decoction in Treating Cesarean Scar Pregnancy

目的 :研究甲氨蝶呤(MTX)、米非司酮联合化瘀消癥汤治疗子宫口瘢痕部异位妊娠(CSP)的临床疗效和安全性。方法 :选取2014年1月—2016年1月我院妇产科收治的83例CSP患者为研究对象,按照随机数字表法分为观察组42例和对照组41例。对照组给予甲氨蝶呤(25 mg,qd)联合米非司酮(25 mg,bid)治疗;观察组在对照组基础上给予化瘀消癥汤(1剂/d,水煎液200 mL,分2次服用)。观察两组治疗7d、14 d后血人绒毛膜促性腺激素(HCG)水平、包块直径变化情况,并比较两组疗效及不良反应发生情况。结果:观察组治疗7d、14d后血HCG水平、包块直径显著低于对照组,且血HCG降至正常水平时间和包块消失时间均短于对照组,差异有统计学意义(P <0.05);观察组治疗有效率显著高于对照组,差异有统计学意义(P <0.05);两组不良反应发生率比较,差异无统计学意义(P> 0.05)。结论 :甲氨蝶呤、米非司酮联合化瘀消癥汤治疗子宫切口瘢痕部异位妊娠的疗效显著,且安全性好,值得临床推广。

Objective: To study the clinical efficacy and safety of methotrexate (MTX) and mifepristone combined with huayu xiaozheng decoction in the treatment of cesarean scar pregnancy (CSP). Methods: 83 patients with CSP admitted to our department of obstetrics and gynecology from January 2014 to January 2016 were selected as subjects investigated and randomly divided into observation group (n=42) and control group (n=41). The patients in the control group were given methotrexate (25 mg, qd) combined with mifepristone (25 mg, bid), and the patients in the observation group were given huayu xiaozheng decoction on the basis of the control group (1 dose/d, decoction 200 mL, taken twice). The levels of human chorionic gonadotropin (HCG) in serum and the diameter of the mass were observed after 7 and 14 days of treatment, and the efficacy and adverse reactions were compared between the two groups. Results: The level of blood HCG level and the diameter of the mass in the observation group were significantly lower than those in the control group after 7 days and 14 days of treatment, and the time of blood HCG falling to normal level and the disappearance time of the mass were significantly shorter than those in the control group (P<0.05). The effective rate in the observation group was significantly higher than that in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Methotrexate and mifepristone combined with huayu xiaozheng decoction are effective and safe in the treatment of CSP and worthy of clinical promotion.