宫腔镜联合甲氨蝶呤在剖宫产瘢痕妊娠中的应用  

Application of hysteroscopy combined with methotrexate in the treatment of caesarean scar pregnancy

作　　者：陈静平[1] 杨洲[1] 郑小敏[1] 阳晓敏[1] 杨静雅[1] 吴裕林[1] 

机构地区：[1]广西医科大学第八附属医院妇产科,537100

出　　处：《中国实用医药》2014年第26期9-11,共3页China Practical Medicine

摘　　要：目的探讨诊断和治疗剖宫产子宫瘢痕妊娠(CSP)的有效方法。方法 34例剖宫产瘢痕妊娠患者,随机分为甲氨蝶呤(MTX)全身化疗组12例(MTX组)及MTX+直接刮宫组(6例),MTX+米非司酮+宫腔镜电切术治疗16例为MTX联合宫腔镜组。观察比较各组疗效。结果入组的34例患者均完成上述治疗,MTX组成功率58.3%,住院时间(24.5±8.3)d;术后血人绒毛膜促性腺激素(β-HCG)恢复正常时间(28.9±15.0)d;直接刮宫组成功率50.0%,手术时间(20.0±7.5)min,术中出血量(316.7±162.5)ml,住院时间(15.5±+5.6)d;术后血β-HCG恢复正常时间(15.5±3.7)d;MTX组联合宫腔镜组,成功率100.0%,手术时间(37.5±12.5)min,术中出血量(45.7±32.5)ml,住院时间(9.5±1.2)d;术后血β-HCG恢复正常时间(10.5±2.7)d;所有患者无一例严重并发症。结论早期超声诊断可以为子宫瘢痕妊娠的治疗提供重要依据,经过MTX+米非司酮治疗后行宫腔镜电切术治疗取得了满意的疗效,优于MTX单药治疗,值得在临床中推广应用。Objective To investigate the effective therapy of diagnosis and treatment of caesarean scar pregnancy （CSP）. Methods A total of 34 cases of CSP were randomly divided into two groups. There were 12 received methotrexate （MTX） systemic chemotherapy （MTX group）, 6 cases received dilatation and curettage, and 16 cases received MTX combined with mifepristone and hysteroscopic resection. Results All treatments were accomplished in 34 cases. The success rate of the MTX group was 58.3%, hospital stays was （24.5 ± 8.3） d, recovery time of human chorionic gonadotropin （ β -HCG） was （28.9 ± 15.0） d. The success rate of the dilatation and curettage group was 50.0%, operation time was （20.0 ＋ 7.5） min, intraoperative bleeding volume was （316.7 ± 162.5） ml, hospital stays was （15.5 ＋ 5.6） d, recovery time ofβ -HCG was （15.5 ± 3.7） d. The success rate of MTX and hysteroscopy group was 100.0%, operation time was （37.5± 12.5） min, intraoperative bleeding volume was （45.7±32.5） ml, hospital stays was （9.5 ±1.2） d, recovery time of β-HCG was （10.5 ±2.7） d. There was no severe complications in the cases. Conclusion Early ultrasound diagnosis can provide important information for the treatment of CSP. The treatment of MTX, mifepristone and hysteroscopic resection is better than MTX therapy alone. The treatment is worthy of clinical popularization and application.

关 键 词：剖宫产 瘢痕妊娠 甲氨蝶口令 米非司酮 宫腔镜 

分 类 号：R713.8[医药卫生—妇产科学]