甲氨蝶呤联合宫腔镜治疗内生型剖宫产瘢痕妊娠的疗效观察  

Therapeutic effect of methotrexate combined with hysteroscopy in the treatment of endogenous cesarean scar pregnancy

作　　者：郑凤雀 林佳静[1] 韦丽锦 方双 何春娜 李晶晶 ZHENG Fengque;LIN Jiajing;WEI Lijin;FANG Shuang;HE Chunna;LI Jingjing(Gynecology Department,the Fourth Affiliated Hospital of Guangxi Medical University(Liuzhou Workers’Hospital),Liuzhou,Guangxi 545005,P.R.China;Gynecology Department,Liuzhou Maternity and Child Healthcare Hospital,Liuzhou,Guangxi 545001,P.R.China)

机构地区：[1]广西医科大学第四附属医院(柳州市工人医院)妇科,广西柳州545005 [2]柳州市妇幼保健院妇科,广西柳州545001

出　　处：《华西医学》2021年第9期1216-1220,共5页West China Medical Journal

基　　金：国家自然科学基金(81303137);广西自然科学基金(2020JJA140059)。

摘　　要：目的探讨术前是否肌内注射甲氨蝶呤对宫腔镜治疗内生型剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的临床疗效。方法前瞻性分析2013年1月-2018年1月就诊于柳州市工人医院妇科的内生型CSP患者94例,随机分为肌内注射甲氨蝶呤后行宫腔镜手术组(甲氨蝶呤组,n=39)和直接行宫腔镜手术组(非甲氨蝶呤组,n=55)。对两组患者手术时间、术中出血量、手术并发症、住院时间、手术费用、血人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)恢复时间及治疗结局进行比较。正态分布资料以均数±标准差表示,非正态分布资料以中位数(下四分位数,上四分位数)表示。结果两组患者的一般情况,包括年龄、孕囊直径、子宫瘢痕厚度、剖宫产次数、剖宫产距今时间、停经时间、术前血HCG值差异均无统计学意义(P>0.05)。两组患者术中出血量[75(35,120)vs.65(35,130)mL,P=0.821]、并发症发生率(5.1%vs.5.5%,P=1.000)、术后血HCG恢复时间[(5.22±2.17)vs.(4.96±1.81)周,P=0.559]、治疗有效率(94.9%vs.90.9%,P=0.747)差异均无统计学意义;甲氨蝶呤组手术时间更长[43(34,55)vs.32(28,35)min,P=0.001],住院时间更长[(10.89±1.42)vs.(5.82±1.47)d,P<0.001],住院费用更高[(8596.46±3336.59)vs.(7058.84±2638.49)元,P=0.014]。结论对于内生型CSP患者,宫腔镜手术前肌内注射甲氨蝶呤对治疗效果并无显著影响,反而增加患者手术时间、住院时间和住院费用。宫腔镜手术前肌内注射甲氨蝶呤并非必需。Objective To explore the clinical effect of intramuscular injection of methotrexate on hysteroscopic treatment of endogenous cesarean scar pregnancy(CSP).Methods A prospective analysis was conducted on 94 patients diagnosed with endogenous CSP who visited the Department of Gynecology in Liuzhou Workers’Hospital between January 2013 and January 2018,and they were randomly divided into two groups,the intramuscular injection of methotrexate followed by hysteroscopic surgery group(the methotrexate group,n=39)and the direct hysteroscopic surgery group(the non-methotrexate group,n=55).The operation time,intraoperative blood loss,surgical complications,length of hospital stay,hospitalization expenses,the recovery time of blood human chorionic gonadotropin(HCG)and treatment outcomes of the two groups were compared.The normally distributed data were expressed as mean±standard deviation,and the non-normally distributed data were expressed as median(lower quartile,upper quartile).Results There was no statistically significant difference in age,gestational sac diameter,uterine scar thickness,number of cesarean sections,time from cesarean section to present,time of menopause,or preoperative blood HCG value between the two groups(P>0.05).There was no statistically significant difference in intraoperative blood loss[75(35,120)vs.65(35,130)mL,P=0.821],incidence of complications(5.1%vs.5.5%,P=1.000),postoperative blood HCG recovery time[(5.22±2.17)vs.(4.96±1.81)weeks,P=0.559]or the effective rate of treatment(94.9%vs.90.9%,P=0.747)between the two groups.The methotrexate group had longer operation time[43(34,55)vs.32(28,35)min,P=0.001],longer length of hospital stay[(10.89±1.42)vs.(5.82±1.47)d,P<0.001],and higher hospitalization cost[(8596.46±3336.59)vs.(7058.84±2638.49)yuan,P=0.014].Conclusion For patients with endogenous CSP,intramuscular injection of methotrexate before hysteroscopic surgery is not necessary,for it has no significant impact on the treatment effect,instead,it may prolong the operation time and length of

关 键 词：剖宫产瘢痕妊娠 宫腔镜 甲氨蝶呤 临床疗效 

分 类 号：R714.22[医药卫生—妇产科学]