米非司酮和甲氨蝶呤联合超声引导下清宫术治疗剖宫产术后子宫切口瘢痕妊娠疗效观察  

Effect of mifepristone and methotrexate combined with ultrasound-guided evacuation in the treatment of uterine incision scar pregnancy after cesarean section

作　　者：张婷 ZHANG Ting(Department of Reproductive Medicine,Luoshan County People′s Hospital,Luoshan 464200,Henan Province,China)

机构地区：[1]罗山县人民医院生殖医学科,河南罗山464200

出　　处：《新乡医学院学报》2022年第6期578-582,共5页Journal of Xinxiang Medical University

摘　　要：目的探讨米非司酮和甲氨蝶呤联合超声引导下清宫术治疗剖宫产术后子宫切口瘢痕妊娠的临床疗效。方法选择2019年4月至2020年8月罗山县人民医院收治的84例剖宫产术后子宫切口瘢痕妊娠患者为研究对象,根据治疗方法将患者分为对照组和观察组,每组42例。对照组患者口服米非司酮50 mg,每日2次,连续治疗3 d为1个疗程。观察组患者在对照组患者治疗基础上首日给予甲氨蝶呤50 mg,肌内注射,然后停药2 d,3 d为1个疗程。2组患者治疗1个疗程后检查血清人绒毛膜促性腺激素(β-hCG)水平,若β-hCG水平未降至入院时1/2~1/3,间隔5 d可重复疗程用药,当β-hCG水平降至入院时的1/2~1/3,行超声引导下清宫术。治疗后3 d,评估2组患者的临疗效果,并计算总有效率。分别于治疗前及治疗后3 d,采用生活质量量表(SF-36)评估患者的生活质量。治疗后3 d,使用经阴道二维超声检测2组患者子宫前壁下段肌层厚度、妊娠物长径。记录2组患者瘢痕部位包块消失时间、住院时间及不良反应发生情况。结果治疗后3 d,对照组和观察组患者治疗总有效率分别为78.57%(33/42)、95.24%(40/42),观察组患者治疗后3 d的治疗总有效率显著高于对照组(χ^(2)=5.126,P<0.05)。2组患者治疗后3 d SF-36中生理功能、情感职能、社会功能、躯体疼痛、精神健康维度评分均显著高于治疗前(P<0.05);治疗后3 d,观察组患者SF-36中生理功能、情感职能、社会功能、躯体疼痛、精神健康维度评分均显著高于对照组(P<0.05)。2组患者治疗后3 d的子宫前壁下段肌层厚度显著大于治疗前,妊娠物长径显著小于治疗前(P<0.05);治疗后3 d,观察组患者的子宫前壁下段肌层厚度显著大于对照组,妊娠物大小显著小于对照组(P<0.05)。观察组患者的瘢痕部位包块消失时间和住院时间均显著短于对照组(P<0.05)。治疗期间,对照组和观察组患者不良反应总发生率分别Objective To investigate the clinical effect of mifepristone and methotrexate combined with ultrasound-guided uterine evacuation in the treatment of uterine incision scar pregnancy after cesarean section.Methods A total of 84 patients with uterine incision scar pregnancy after cesarean section who were admitted to Luoshan County People′s Hospital from April 2019 to August 2020 were selected as the research objects.According to the treatment methods,the patients were divided into the control group and the observation group,with 42 patients in each group.The patients in the control group were given mifepristone orally,twice a day,50 mg each time,continuous treatment for 3 days as a course of treatment.On the basis of the treatment in the control group,the patients in the observation group were given methotrexate 50 mg intramuscularly on the first day,and then stopped for 2 days and 3 days was a course of treatment.After one course of treatment,the serumβ-human chorionic gonadotropin(β-hCG)level of patients in the two groups was detected.If the level ofβ-HCG did not decrease to 1/2 to 1/3 of the level ofβ-HCG at the admission,the course of treatment could be repeated at an interval of 5 days.When theβ-hCG level dropped to 1/2 to 1/3 of the level ofβ-HCG at the admission,ultrasound-guided hysterectomy was performed.Three days after treatment,the clinical efficacy of patients in the two groups was evaluated,and the total effective rate was calculated.Before treatment and 3 days after treatment,the quality of life of the patients in the two groups was assessed by short form 36 questionnaire(SF-36).At 3 days after treatment,the thickness of muscular layer of inferior anterior uterine wall and the long diameter of pregnancy of patients in the two groups was detected by transvaginal two-dimensional ultrasonography.The disappearance time of the scar mass,the time of hospital stay and the occurrence of adverse reactions of patients in the two groups were recorded.Results At 3 days after treatment,the total effective

关 键 词：超声引导下清宫术 剖宫产 子宫切口瘢痕妊娠 米非司酮 甲氨蝶呤 

分 类 号：R714.22[医药卫生—妇产科学]