瘢痕妊娠药物保守治疗后疗效分析与评价  

Curative effect and evaluation of conservative medication on scar pregnancy

作　　者：王奕芳[1] 王亦雄[1] 黄涛[1] 顾小燕[1] 

机构地区：[1]扬州市妇幼保健院妇产科,江苏扬州225000

出　　处：《中国妇幼健康研究》2015年第2期371-373,共3页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨剖宫产术后瘢痕妊娠(CSP)患者妊娠物局部注射甲氨蝶呤(MTX)治疗后,经阴道超声检查是否对疗效评价有意义,如何早期发现病程中大量阴道流血的患者,及早进行干预。方法回顾性分析扬州市妇幼保健院收治的21例CSP患者,分析治疗前后超声影像学的改变对治疗效果评价有无辅助作用,病程中发生大量阴道流血的患者的临床特点。结果所有患者治疗前后超声均有改变,联合血β-人绒毛促性腺激素(β-hCG)分析,治疗后B超影像学检查可用于评价疗效。21例CSP病程中阴道流血≥200mL者5例,其中妊娠囊型2例,包块型3例,病程中复查B超均发现包块进行性增大,如合并血流丰富者,则更易发生难以控制的阴道大量流血。结论治疗后B超影像学检查可用于药物保守治疗效果的评价,药物保守治疗后B超提示包块增大或妊娠物周边血流丰富,则病程中极易发生难以控制的阴道大量流血。Objective To investigate curative effect of local injection of Methotrexate （ MTX） on cesarean scar pregnancy （ CSP） and how to detect and prevent severe vaginal bleeding.Methods A retrospective analysis was conducted on the data of 21 cases of CSP admitted in Yangzhou Women and Child Health Hospital.The changes in ultrasonic images were analyzed, and the clinical features of the patients with severe vaginal bleeding were analyzed, too.Results There was change in ultrasonographic results after treatment in all patients.Combined with serumβ-hCG, B-ultrasonic inspection could be used to evaluate therapeutic effect.There were 5 cases with vaginal bleeding≥200mL in the course of CSP, including 2 cases of pregnancy sac type and 3 cases of mass type.The mass progressively grew found by B-ultrasonic reexamination.For cases complicated with large bleeding, uncontrolled vaginal bleeding occurred easily. Conclusion B-ultrasonic inspection can be used to evaluate the therapeutic effect of medication.If B-ultrasonic inspection indicates growing of mass or rich blood flow around conceptus, the CSP patients will suffer severe vaginal bleeding easily.

关 键 词：剖宫产术后瘢痕妊娠 经阴道多普勒彩超 药物保守治疗 甲氨蝶呤 

分 类 号：R714.2[医药卫生—妇产科学]