不同剂量MTX经动脉灌注治疗切口妊娠疗效的分析  

Intra-arterial infusion of MTX for the treatment of cesarean scar pregnancy:a comparative study between different doses

作　　者：顾伟瑾[1] 王海云[1] 万军[1] 张磊[1] 王颖[1] 王玮[1] 季芳[1] 纪莉华[1] 

机构地区：[1]上海市静安区中心医院介入科,200040

出　　处：《介入放射学杂志》2010年第7期568-571,共4页Journal of Interventional Radiology

摘　　要：目的探讨剖宫产后切口瘢痕妊娠经子宫动脉灌注MTX的有效剂量。方法孕周在5～9周的36例切口瘢痕妊娠,经两侧子宫动脉灌注MTX,剂量从60mg起逐渐加至100、150、200mg,每一剂量组均为9例,灌注后用明胶海绵阻塞两侧子宫动脉直至DSA下子宫动脉造影染色消失,3d至1周内行刮宫术。结果介入术后1周内血β-HCG和血孕酮的下降速度与MTX用量大小存在一定关系。60、200mg间差异有统计学意义(P<0.05),100、150mg组间差异无统计学意义(P<0.05)。住院时间200mg组<100、150mg组<60mg组。结论切口妊娠经动脉灌注MTX的有效用量建议为200mg,介入术后可杀死胚胎,迅速降低血β-HCG和血孕酮,缩短住院日期。Objective To investigate the effective dose of methotrexate（MTX） via intra-arterial infusion for the treatment of cesarean scar pregnancy.Methods Thirty-six cases of incisional scar pregnancy at the gestational age of 5-9 weeks received bilateral uterine arterial infusion of MTX.According to the dose of MTX used,the patients were randomly and equally divided into four groups with MTX dose of 60,100,150 and 200 mg respectively.After the perfusion was completed the embolization of both uterine arteries with Gelfoam was carried out until the uterine arteries were no longer visualized on DSA.Uterine curettage was conducted within 1-7 days after the treatment.Results In one week after the procedure,the difference in the decreasing rate of serum β-HCG and progesterone between group 60 mg and group 200 mg was of statistical significance（P〈0.05）.While a certain relationship existed between the MTX dose and the decreasing rate of serum β-HCG as well as progesterone in both group 100 mg and group 150 mg,but the difference was of no statistical significance（P〈0.05）.The hospitalization days of group 60 mg was the longest,while that of group 200 mg was the shortest.Conclusion The recommended dose of MTX used via intra-arterial infusion in treating cesarean scar pregnancy is 200 mg.The interventional procedure can kill the embryo tissue and quickly lower the serum β-HCG and progesterone levels,it can also shorten the patient＇s hospitalization time.

关 键 词：剖宫产后切口妊娠 动脉灌注 甲氨蝶呤 

分 类 号：R714.22[医药卫生—妇产科学]