药物预处理联合宫腔镜手术对剖宫产术后子宫瘢痕妊娠疗效的改善作用  

Effectiveness of hysteroscopy and Yin type lesion resection combined with drug pretreatment in patients with uterine scar pregnancy

作　　者：陈萍[1] 王斌[2] 

机构地区：[1]湖北省黄梅县人民医院妇产科,湖北黄梅435500 [2]湖北省黄梅县人民医院神经外科,湖北黄梅435500

出　　处：《临床药物治疗杂志》2017年第5期48-52,共5页Clinical Medication Journal

摘　　要：目的:比较宫腔镜与阴式病灶切除术联合与不联合药物预处理治疗子宫瘢痕妊娠的疗效。方法:回顾性分析2014年5月至2016年6月于本科室治疗剖宫产术后子宫瘢痕妊娠70例临床案例。按照其治疗方式不同,分为观察组和对照组,各35例。对照组给予宫腔镜与阴式病灶切除进行子宫瘢痕治疗,观察组在对照组基础上给予米非司酮(每次20mg,bid,连续口服3 d)和手术前3 d、手术前1 d分别给予患者臀部肌肉注射甲氨蝶呤50mg·m-2。统计分析两组患者治疗后疗效、临床资料、治疗前后包块大小、血清β-HCG及手术后并发症发生情况。结果:观察组患者有效率(94.29%)高于对照组(71.43%),差异具有统计学意义(P<0.05);与对照组相比,观察组患者术中出血量(52.36±1.32)mL、β-HCG恢复时间(16.85±2.96)d、阴道流血时间(5.96±1.05)d、住院时间(8.96±2.32)d、月经来潮(38.86±4.62)d、随访痊愈时间(40.73±2.84)d均明显减少,差异均有统计学意义(P<0.05);与对照组相比,治疗后观察组妊娠包块大小(2.15±0.86)cm、β-HCG量(398.62±188.55)mIU·mL^(-1)均明显减小,差异具有统计学意义(P<0.05);观察组术后总并发症低于对照组(34.29%),差异具有统计学意义(P<0.05)。结论:药物预处理联合宫腔镜与阴式病灶切除术能有效提高子宫瘢痕妊娠治疗效果,提高手术安全性,促进患者术后恢复,值得临床进一步推广应用。Objective： To investigate the effectiveness of hysteroscopy and Yin type lesion resection combined with drug pretreatment in patients with uterine scar pregnancy. Methods： Seventy bronchial asthma patients were retrospectively analyzed from May 2014 to June 2016 in our hospital.According to the treatment way, the patients were divided into experimental group （n=35） and control group（n=35）. The control group was given hysteroscopy and Yin type lesion resection of uterine scar treatment.The experimental group was given mifepristone and methotrexate on the basis of the treatment given to the control group. Statistical analysis was performed for the curative effect, clinical data, package size and quantity of beta HCG before and after the treatment, and complications after the operation. Results： The total effective rate （94.29%）of the experimental group was statistically higher than the control group （71.43%） （P〈0.05）. Compared with the control group, the intraoperative blood loss （52.36±1.32）mL, beta HCG time（16.85±2.96）d, vaginal bleeding time（5.96±1.05）d, length of hospital stay（8.96±2.32）d, menstrual cramps（38.86±4.62）d, follow-up recovery time（40.73±2.84）d of the experimental group were significantly reduced （P〈0.05）. After treatment,compared with the control group,the package block size（2.15±0.86） cm and the level of beta HCG pregnancy （398.62±188.55）miU·mL^-1 of the experimental group were significantly reduced （P〈0.05）. The incidence of postoperative complications of beta HCG pregnancy of the experimental group was lower than the control group（34.29%）, the difference was statistically significant （P〈0.05）. Conclusion： Hysteroscopy and Yin type lesion resection combined with drug pretreatment can effectively improve the treatment effect of uterine scar pregnancy, improve the safety of surgery, and promote postoperative recovery and itis worth further promotion in clinic.

关 键 词：米非司酮 联合 甲氨蝶呤 宫腔镜 阴式病灶切除术 子宫瘢痕妊娠 

分 类 号：R969.3[医药卫生—药理学]