子宫切口妊娠的个体化治疗疗效探讨  

Efficacy of individualized treatment for cesarean scar pregnancy

作　　者：伍桂香[1] 庄小兰[1] 段海英[1] 王芳[1] 白群[1] Wu Guixiang;Zhuang Xiaolan;Duan Haiying(The Central People's Hospital of Ji'an City,Ji'an,Jiangxi 343000)

机构地区：[1]吉安市中心人民医院

出　　处：《基层医学论坛》2019年第31期4443-4444,共2页The Medical Forum

基　　金：吉安市科技计划项目

摘　　要：目的探讨剖宫产术后子宫切口妊娠个体化治疗的疗效。方法选取2016年1月-2018年1月期间我院接收的剖宫产术后子宫切口妊娠患者40例,根据患者的切口厚度、包块大小及阴道出血情况综合考虑分为介入组、甲氨蝶呤(MTX)肌注组和米非司酮组。介入组选取26例彩色多普勒超声提示子宫切口厚度<4 mm或阴道出血多的患者采取子宫动脉栓塞+刮宫术;MTX肌注组选取11例彩色多普勒超声提示子宫切口厚度>4 mm且入院前无出血或阴道出血少的患者采取甲氨蝶呤肌肉注射+刮宫术;米非司酮组选取3例行米非司酮+米索前列醇药物流产。比较介入组与MTX肌注组的治疗效果(因米非司酮组例数少,未与其他2组病例进行统计学分析)。结果介入组血β-HCG下降至正常天数与住院时间均短于MTX肌注组,差异有统计学意义(P<0.05)。米非司酮组胎物自然流出,未清宫。结论剖宫产术后子宫切口妊娠患者实行个体化治疗可避免切除子宫,挽救生命。Objective To investigate the efficacy of individualized treatment for cesarean scar pregnancy after cesarean section. Methods 40 patients with cesarean scar pregnancy after cesarean section in the hospital from January 2016 to January 2018 were selected. They were divided into intervention group,methotrexate(MTX)intramuscular injection group,mifepristone group according to the thickness of the incision,size of the mass and vaginal bleeding. In the intervention group,26 patients with color Doppler ultrasound suggesting uterine incision thickness<4 mm or more vaginal bleeding were treated with uterine artery embolization and curettage;In the MTX intramuscular injection group,11 patients with color Doppler ultrasound showed uterine incision thickness>4 mm and no bleeding or vaginal bleeding before admission were given MTX intramuscular injection and curettage. In the mifepristone group,3 cases were given medical abortion with mifepristone and misoprostol.The curative effects of intervention group and MTX intramuscular injection group were compared. The number of patients in mifepristone group was small,so that it was not included in the statistical analysis of the other two groups.Results The duration of bloodβ-HCG dropping to the normal level and the hospital stays in intervention group were shorter than those in MTX intramuscular injection group,and the difference was statistically significant(P<0.05). The fetuses in mifepristone group naturally flowed out,without curettage. Conclusion Individualized treatment for cesarean scar pregnancy after cesarean section can avoid the the excision of the uterus,and save the lives of patients.

关 键 词：子宫切口妊娠 个体化治疗 介入 甲氨蝶呤 米非司酮 

分 类 号：R714.22[医药卫生—妇产科学]