甲氨蝶呤联合宫腔镜下手术治疗剖宫产后子宫瘢痕妊娠的价值  

Value of methotrexate combined with hysteroscopic surgery in the treatment of cesarean scar pregnancy after cesarean section

作　　者：王在巧 Wang Zai-qiao(Department of Gynecology,Pingdingshan Maternal and Child Health Hospital,Pingdingshan 476000,Henan,China)

机构地区：[1]平顶山市妇幼保健院妇科,河南平顶山476000

出　　处：《四川生理科学杂志》2023年第10期1826-1829,共4页Sichuan Journal of Physiological Sciences

摘　　要：目的:观察甲氨蝶呤(Methotrexate,MTX)联合宫腔镜下手术治疗剖宫产后子宫瘢痕妊娠(Cesarean Scars Pregnancy,CSP)的临床效果与价值。方法:选取2019年1月至2021年12月在我院治疗的CSP患者60例,将其按照单双号法随机分为对照组和联合组(n=30),对照组采用宫腔镜下手术进行治疗,联合组则在其基础上联合MTX治疗。比较两组围术期基本情况(手术时间、术中出血量、住院时间),治疗后2 w采用化学发光法测定人绒毛膜促性腺激素(β-hCG)水平;统计两组患者术后恢复情况,包括阴道持续流血时间、β-hCG(<3 mIU·mL-1)恢复时间,月经恢复时间;治疗前、术后2 w、术后1 m、术后2 m行B超检查,观察两组患者子宫瘢痕病灶直径大小;治疗前、术后2 w行多普勒超声检查,观察子宫动脉血流动力学指标:收缩期与舒张末期血流速比(Peak Systolic Velocity/End Diastolic Velocity,PSV/EDV)、阻力指数(Resistance Index,RI)、搏动指数(Pulsatility Index,PI);同时记录两组术后并发症发生率。结果:两组手术时间比较无统计学差异(P>0.05),联合组术中出血量、住院时间低于对照组(P<0.05),联合组患者阴道持续流血时间、β-hCG恢复时间、月经恢复时间均低于对照组(P<0.05);术后2 w、术后1 m、术后2 m,与治疗前相比,两组子宫瘢痕处病灶直径均明显降低(P<0.05),其中联合组降低更为显著(P<0.05);术后2 w,与治疗前相比,两组患者PSV/EDV、RI、PI水平均明显降低(P<0.05),其中联合组下降更显著(P<0.05);两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论:MTX联合宫腔镜下手术治疗CSP患者的临床效果较好,可有效降低术中出血量,促进子宫瘢痕病灶和子宫功能恢复,且安全性高,具有较高临床应用价值。Objective:To observe the clinical effect and value of methotrexate(MTX)combined with hysteroscopic surgery in the treatment of cesarean scar pregnancy(CSP)after cesarean section.Methods:A total of 60 patients with CSP who were treated in the hospital from January 2019 to December 2021 were selected and randomly divided into the control group and the combined group(n=30)according to the odd-even number method.The control group was treated with hysteroscopic surgery while the combined group was combined with MTX on this basis.The perioperative basic conditions(surgical time,intraoperative blood loss,hospital stay)were compared between the two groups.The level of human chorionic gonadotropin(β-hCG)was measured by chemiluminescence at 2 w after treatment.The postoperative recovery conditions were counted in both groups,including duration of continuous vaginal bleeding,β-hCG recovery time(<3 mIU·mL-1),and menstrual recovery time.B ultrasound examination was performed before treatment and at 2 w,1 m,and 2 m after surgery to observe the uterine scar lesion diameter.Doppler ultrasound examination was performed before treatment and at 2 w after treatment to observe the uterine artery hemodynamic indicators of peak systolic velocity/end-diastolic velocity ratio(PSV/EDV)and resistance index(RI)pulsatility index(PI),and the incidence rates of postoperative complications of the two groups were recorded.Results:There was no statistical difference in the surgical time between the two groups(P>0.05).The intraoperative blood loss and hospital stay in the combined group were less or shorter than those in the control group(P<0.05),and the duration of continuous vaginal bleeding,β-hCG recovery time,and menstrual recovery time were shorter than those in the control group(P<0.05).At 2 w,1 m,and 2 m after surgery,the uterine scar lesion diameter in both groups was significantly decreased compared to pretreatment(P<0.05),and the decrease was more significant in the combined group(P<0.05).At 2 w after surgery,the PSV/EDV,RI,and PI in

关 键 词：甲氨蝶呤 宫腔镜 剖宫产 子宫瘢痕妊娠 

分 类 号：R719.8[医药卫生—妇产科学]