宫腔镜手术联合药物治疗剖宫产瘢痕妊娠患者的疗效观察  

Observation on the clinical effect of hysteroscopic surgery combined with drug therapy in treatment of patients with cesarean scar pregnancy

作　　者：易姗祺[1] 顾荣花[1] 胡彩华[1] 钟永红[1] 李高文[2] 

机构地区：[1]汕头大学医学院附属粤北人民医院妇产科,广东韶关512026 [2]汕头大学医学院附属粤北人民医院肿瘤内科,广东韶关512026

出　　处：《中国妇幼保健》2017年第15期3643-3646,共4页Maternal and Child Health Care of China

基　　金：2013韶关市医药卫生科研计划项目(Y13163)

摘　　要：目的探讨剖宫产瘢痕妊娠(CSP)患者采用宫腔镜手术联合药物治疗的临床效果。方法以2015年3月-2016年3月该院收治的CSP患者104例为研究对象。按照就诊先后顺序分为观察组(甲氨蝶呤+宫腔镜直视下局部电切术)与对照组(甲氨蝶呤+B超定位下负压吸引清宫术)各52例。治疗后随访6个月,对比两组治疗效果。结果观察组患者手术时间、术中出血量、阴道流血时间、月经恢复时间、术后血β-hCG下降至正常时间、住院时间均优于对照组,差异有统计学意义(t=5.217、19.302、8.448、8.417、9.127、27.201,均P<0.05);治疗后6个月,观察组妊娠率80.77%(42/52)高于对照组53.85%(28/52),差异有统计学意义(χ~2=8.57,P<0.05);观察组复发率1.92%(1/52)低于对照组13.46%(7/52),差异有统计学意义(χ~2=4.88,P<0.05);所有患者均未出现相关并发症。结论在CSP患者的临床治疗过程中,采用甲氨蝶呤肌内注射与宫腔镜手术联合治疗的效果显著,能缩短患者手术时间、阴道流血时间、月经恢复时间、术后血β-hCG下降至正常时间、住院时间,减少术中出血量,且能降低复发率,提升妊娠率,值得推广应用。Objective To explore the clinical effect of hysteroscopic surgery combined with drug therapy in treatment of cesarean scar pregnancy（ CSP）. Methods A total of 104 CSP patients treated in the hospital from March 2015 to March 2016 were selected as study objects. According to the sequence of hospital admission,they were divided into observation group（ methotrexate＋local electric hysteroscopy resection） and control group（ methotrexate＋ultrasound-guided suction curettage）,52 cases in each group. The curative effects were compared between the two groups after 6-month follow-up. Results Operation time,bleeding volume,vaginal bleeding time,menstrual recovery time,the time of postoperative blood β-human chorionic gonadotropin（ β-hCG） decreasing to normal level,and hospitalization time in observation group were statistically significantly better than those in control group（ t = 5. 217,19. 302,8. 448,8. 417,9. 127,27. 201,all P〈0. 05）; at 6 months after treatment,the pregnancy rate in observation group was 80. 8%（ 42/52）,which was statistically significantly higher than that in control group（ 53. 8%,28/52）（ χ~2= 8. 57,P〈0. 05）; the recurrence rate in observation group was 1. 92%（ 1/52）,which was statistically significantly lower than that in control group（ 13. 46%,7/52）（ χ~2= 4. 88,P〈0. 05）; no relevant complication occurred among all the patients. Conclusion CSP patients treated with hysteroscopic surgery combined with intramuscular injection of methotrexate has significant curative effect in the process of clinical treatment,the therapy can shorten operation time,vaginal bleeding time,menstrual recovery time,the time of postoperative blood β-hCG decreasing to normal level,hospitalization time,and it can also reduce the amount of bleeding in operation and the recurrence rate,improve pregnancy rate,which is worthy of promotion and application.

关 键 词：剖宫产瘢痕妊娠 甲氨蝶呤 宫腔镜手术 

分 类 号：R714[医药卫生—妇产科学]