剖宫产瘢痕妊娠两种治疗方法分析  

Analysis of two methods for the treatment of cesarean scar pregnancy

作　　者：梁海霞[1] 陈必良[2] 李玉虹[1] 张魁[1] 李天秀[1] 

机构地区：[1]解放军451医院妇产科,陕西西安710054 [2]第四军医大学西京医院妇产科,陕西西安710032

出　　处：《现代医学》2016年第3期299-302,共4页Modern Medical Journal

基　　金：西安市医学攻关项目[SF1324(4)]

摘　　要：目的:分析剖宫产瘢痕妊娠行氨甲喋呤(MTX)胎囊注射后B超监测下清宫术和单纯MTX胎囊注射两种治疗方法的疗效。方法:回顾性分析35例剖宫产瘢痕妊娠患者的临床资料,按其治疗方法分为两组,一组行MTX胎囊注射后B超监测下清宫术(清宫组22例),一组行单纯MTX胎囊注射术(MTX组13例),对比两组疗效。结果:35例患者均未切除子宫。清宫组22例无子宫穿孔,1例发生宫腔粘连;清宫组阴道出血时间、血人绒毛膜促性腺激素(HCG)转阴时间及B超下局部包块吸收时间分别为(6.9±1.6)、(16.1±2.6)和(8.2±2.6)d,均短于MTX组的(15.8±1.6)、(24.8±8.1)和(43.1±19.1)d(均P<0.01);清宫组恢复正常月经时间为(54.8±9.2)d,长于MTX组的(35.5±4.8)d(P<0.01)。结论:MTX胎囊注射后B超监测下清宫术及单纯MTX胎囊注射均可用于剖宫产瘢痕妊娠的治疗,前者疗效优于后者。Objective： To explore the efficiency of two treatments and to find a better treatment to control cesarean scar pregnancy（ CSP）. Methods： Thirty-five CSP patients were divided into two groups. Group one（ 22 cases） was treated with curettage under the surveillance of ultrasound after the placenta injection of MTX. Group two（ 13cases） was treated only with injection of MTX to the placenta. The curative effect was compared by measuring the bleeding time of the vagina,the time when human chorionic gonadotropin（ HCG） became negative and the absorption of the local lump. Results： All 35 patients did not receive hysterectomy after the treatments. In the group one,no perforated womb was found and only one patient was found to have intrauterine adhesions. However in group two,no patients were found to have perforated womb and intrauterine adhesions. The bleeding time of the vagina,the time when HCG became negative and the absorption time of the local lump in group one were significantly shorter than those in group two. However,it took longer time for patients in group one to resume normal menses. Conclusion： Both treatments have good curative effect on CSP. Curettage under the surveillance of ultrasound in addition to injection of MTX to the placenta is more efficient.

关 键 词：剖宫产瘢痕妊娠 氨甲喋呤 清宫术 

分 类 号：R714.22[医药卫生—妇产科学]