囊胚破坏加甲氨蝶呤孕囊内注射治疗剖宫产术后子宫瘢痕妊娠的临床研究  

A clinical comparative study of methotrexate intrauterine injection in the treatment for cesarean scar pregnancy

作　　者：南刚[1] 惠旭东 马晓娟 薛瑞娟[1] 李丽春[1] 

机构地区：[1]延安大学附属医院妇产科,延安716000

出　　处：《天津医药》2017年第10期1061-1063,共3页Tianjin Medical Journal

摘　　要：目的分析囊胚破坏加甲氨蝶呤(MTX)孕囊内注射治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床疗效,探讨其临床意义。方法选择延安大学附属医院妇产科2013年6月—2016年12月间诊治的剖宫产术后子宫瘢痕妊娠患者共77例,将采用囊胚破坏加甲氨蝶呤孕囊内注射治疗者40例纳入观察组,采用子宫动脉栓塞联合清宫术治疗者37例纳入对照组,观察并记录2组患者术后阴道出血时间、术后血人绒毛膜促性腺激素(HCG)降至正常时间、平均住院费用以及治疗成功率,所有患者采取门诊复查随访。结果观察组术后阴道出血时间[(22.1±6.7)d vs.(29.5±10.8)d]和治疗费用[(8 774.2±714.5)元vs.(15 258.3±1 084.2)元]少于对照组(P<0.001)。2组术后血HCG降至正常时间[(26.4±9.0)d vs.(25.1±10.4)d]和治疗成功率(87.5%vs.91.9%)差异无统计学意义(P>0.05);2组均无大出血者及先兆瘢痕破裂者。结论囊胚破坏加MTX宫腔内注射治疗剖宫产术后子宫瘢痕妊娠,方法操作难度低,临床疗效肯定,费用少,适合基层医院推广使用。Objective To analyse the clinical efficacy of methotrexate(MTX) combined with intrauterine embryo sacgarrotte injection in the treatment of cesarean scar pregnancy(CSP), and discuss its clinical significance. Methods A totalof 77 patients with CSP treated in our hospital during June 2013 to December 2016 were selected in this study. Fortypatients treated with embryo sac destruction and methotrexate injection were included in the observation group, while 37 cases treated by uterine artery embolization combined with curettage were used as the control group. The time of vaginalbleeding, the time of postoperative blood level of human chorionic gonadotropin(HCG) returned to the normal level, averagehospitalization cost and the curative rate were recorded in two groups. All patients were followed up by the outpatient visit.Results In the observation group, the vaginal bleeding time [(22.1±6.7) days vs.(29.5±10.8) days] and treatment cost[(8 774.2±714.5) yuan vs.(15 258.3±1 084.2) yuan] were less than those of the control group(P<0.001). There were nosignificant differences in the recovery time of HCG [(26.4±9.0) days vs.(25.1±10.4) days] and treatment success rate(87.5% vs.91.9%) between the two groups(P>0.05). No bleeding or threatened rupture of scar were found in two groups of patients.Conclusion In this study, we take the embryo sac puncture combined with methotrexate injection in the treatment of scarpregnancy. This method has the advantages of low operative difficulty, definite clinical curative effect and low cost

关 键 词：甲氨蝶呤 剖宫产术 瘢痕妊娠 囊胚破坏 子宫动脉栓塞 

分 类 号：R714.2[医药卫生—妇产科学]