全身或局部应用甲氨蝶呤联合手术治疗晚期剖宫产瘢痕部位妊娠的疗效及超声参数特征分析  

Analysis of therapeutic effect and ultrasonic parameters of systemic or local methotrexate injection combined surgery in management of late cesarean scar pregnancy

作　　者：程晓彤 宋丹阳[2] 刘志辉[1] 牛菊敏[1] CHENG Xiaotong;SONG Danyang;LIU Zhihui;NIU Jumin(Department of Gynecology,Shenyang Women′s and Children′s Hospital,Shenyang 110011,China;Department of Ultrasonography,Shenyang Women′s and Children′s Hospital,Shenyang 110011,China)

机构地区：[1]沈阳市妇婴医院妇科,沈阳110011 [2]沈阳市妇婴医院超声科,沈阳110011

出　　处：《新疆医科大学学报》2023年第7期902-907,共6页Journal of Xinjiang Medical University

基　　金：沈阳市科技计划项目(20-205-4-036)。

摘　　要：目的探讨全身或局部应用甲氨蝶呤(MTX)预处理联合不同时机手术治疗晚期剖宫产瘢痕部位妊娠(CSP)(孕周≥8周)的有效性及安全性,并探究不同联合治疗方案MTX预处理前后的超声参数特征。方法纳入2020年1月至2022年11月于沈阳市妇婴医院诊断晚期剖宫产瘢痕部位妊娠行MTX预处理联合手术治疗的患者160例。按MTX预处理方式及预处理后手术时机分为:A组(肌注MTX后4天手术)、B组(肌注MTX后7天手术)、C组(局部注射MTX后4天手术)、D组(局部注射MTX后7天手术),比较各组联合治疗成功率、围手术期相关临床指标及MTX预处理前后超声参数。结果C、D组治疗成功率分别为95%、97.5%,均高于A、B组(77.5%、80%)(P均<0.05);肌注MTX组术中大出血发生率、MTX副作用发生率及术中出血量均高于局部注射MTX组(P均<0.05);MTX预处理后4天手术组住院时间、住院费用均少于预处理后7天手术组(P均<0.05);局部注射MTX组预处理后超声血流参数VI、FI、VFI及妊娠组织植入体积均小于肌注MTX组(P均<0.05)。结论局部应用MTX预处理后4天联合手术治疗晚期CSP治疗成功率高、术中出血少、MTX副作用发生率低、住院时间短、住院费用低,是较适宜的联合治疗方案。CSP区域超声血流参数及妊娠组织植入体积可能是MTX不同预处理方案联合不同时机手术治疗CSP疗效差异的原因。Objective To investigate the effectiveness and safety of systemic or local methotrexate(MTX)injection combined with surgery at different opportunities in the treatment of late stage(≥8 weeks of gestation)cesarean scar pregnancy(CSP),and to analysis ultrasonic parameters before and after MTX preconditioning of different combined therapies.Methods A prospective randomized study was conducted in the hospital.A total of 160 patients with over 8 weeks of gestation CSP were recruited in the research from January 2020 to November 2022.All patients received MTX pretreatment combined with surgery and were randomly assigned to four groups according to systemic or local MTX and the interval between MTX and surgery.Group A:systemic MTX 4 days followed by surgery,group B:systemic MTX 7 days followed by surgery,group C:local MTX 4 days followed by surgery,group D:local MTX 7 days followed by surgery.The success rates of combine treatment,perioperative and ultrasonic parameters were compared among the four groups.Results The success rates of combine therapy in group C and group D were 95%and 97.5%,respectively,which were statistically higher than those of group A and B(77.5%,80%,P<0.05).The incidence of intraoperative massive hemorrhage,side effects of MTX and intraoperative blood loss in systemic MTX group were higher than those in local MTX group(all P<0.05).The length of hospital stay and hospitalization cost in 4-day surgery group after MTX pretreatment was less than those in 7-day surgery group(all P<0.05).Compared with systemic MTX group,local MTX group's vascular index(VI),flow index(FI),blood flow index(VFI)values and implantation volume of lesion detected by ultrasound was significant lower(all P<0.05).Conclusion Local MTX injection 4 days followed by surgery to treat≥8 weeks CSP is a more appropriate combined treatment scheme.Because of the treatment success rate is high,intraoperative blood loss and side effect of MTX is low,moreover,the hospital stay is short and hospitalization cost is low.The ultrasound blood

关 键 词：剖宫产瘢痕部位妊娠 甲氨蝶呤 手术 超声检查 前瞻性研究 

分 类 号：R714.22[医药卫生—妇产科学]