超声监控下介入治疗及清宫术在治疗内生型CSP中的应用价值  

Application Value of Interventional Therapy Combined with Dilatation and Curettage under Ultrasonic Monitoring in the Treatment of Endogenous Caesarean Scar Pregnancy

作　　者：王雪松 张海静 文颖 周子敬 WANG Xuesong;ZHANG Haijing;WEN Ying;ZHOU Zijing(Department of obstetrics and gynecology,Fourth People’s Hospital of Langfang City,Langfang,Hebei 065700)

机构地区：[1]廊坊市第四人民医院妇产科,河北廊坊065700

出　　处：《智慧健康》2023年第15期133-136,共4页Smart Healthcare

基　　金：廊坊市科学技术研究与发展计划(已获河北医学科技奖一等奖)《超声技术在剖宫产瘢痕部位妊娠治疗中的应用研究》(项目编号:2019013101)。

摘　　要：目的 探讨超声监控下介入治疗及清宫术(D&C)在治疗内生型剖宫产瘢痕部位妊娠(CSP)中的应用价值。方法 内生型CSP患者86例分为A组50例和B组36例,A组采用米非司酮口服、甲氨蝶呤肌肉注射联合超声监测下D&C治疗;B组采用米非司酮口服、孕囊液抽吸、甲氨蝶呤孕囊内注射、聚桂醇硬化联合超声监测下D&C治疗。比较两组术中出血量、临床治愈率、强化手段治疗比例、住院时间、治疗后阴道出血时间、月经恢复正常时间、β-HCG恢复时间、病灶消失时间。不良反应、治疗后子宫瘢痕厚度。结果 B组术中出血量少于A组(P<0.05)、临床治愈率高于A组(P<0.05)、强化手段治疗率低于A组(P<0.05)。B组住院时间及治疗后阴道出血时间、月经恢复正常时间、β-HCG恢复时间、病灶消失时间短于A组(P<0.05)。结论 米非司酮口服、孕囊液抽吸、甲氨蝶呤孕囊内注射、聚桂醇硬化联合超声监测下D&C治疗内生型CSP的疗效优于米非司酮口服、甲氨蝶呤肌肉注射联合超声监测下D&C,且安全性较高。Objective To probe into the application value of interventional therapy and dilatation and curettage(D&C)under ultrasonic monitoring in the treatment of endogenous caesarean scar pregnancy(CSP).Methods Eighty-six patients with endogenous CSP were divided into group A(n=50)and Group B(n=36)according to treatment methods.Group A was treated with mifepristone oral administration,methotrexate intramuscular injection and D&C under ultrasonic monitoring,group B was treated with mifepristone oral administration,gestational sac fluid suction,methotrexate gestational sac injection,lauromacrogol hardening,D&C under ultrasonic monitoring.Intraoperative blood loss,clinical cure rate,proportion of intensive treatment,length of hospital stay,time of vaginal bleeding after treatment,time of normal menstruation,recovery time ofβ-HCG,and time of lesion disappearance were compared between the two groups.Adverse reactions and thickness of uterine scar after treatment were compared.Results In group B,the intraoperative blood loss was less than that in group A(P<0.05),the clinical cure rate was higher than that in group A(P<0.05),and the treatment rate by intensive means was lower than that in group A(P<0.05).In group B,The length of stay,the time of vaginal bleeding,the normal time of menstruation,the recovery time ofβ-HCG and the disappearance time of lesion after treatment were shorter than those in group A(P<0.05).Conclusion The curative effect of mifepristone oral administration,gestational sac fluid suction,methotrexate gestational sac injection,lauromacrogol hardening combined with D&C under ultrasonic monitoring is better than that of mifepristone oral administration,methotrexate intramuscular injection combined with D&C under ultrasonic monitoring in the treatment of endogenous CSP,and high safety.

关 键 词：剖宫产瘢痕部位妊娠 内生型 孕囊 米非司酮 甲氨蝶呤 聚桂醇 清宫术 超声监控 

分 类 号：R714.22[医药卫生—妇产科学]