超声引导下孕囊注射甲氨蝶呤联合宫腔镜手术治疗剖宫产瘢痕妊娠的疗效及对β-HCG水平的影响研究  

Study on effect of ultrasound-guided inguinal injection of methotrexate combined with hysteroscopy on treatment of cesarean scar pregnancy and effect on hCG level

作　　者：崔继敏 沈秋叶 贾灿灿 CUI Ji-min;SHEN Qiu-ye;JIA Can-can(Department of Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院妇科,郑州450000

出　　处：《医药论坛杂志》2024年第19期2091-2094,2098,共5页Journal of Medical Forum

摘　　要：目的探讨宫腔镜手术联合孕囊内注射甲氨蝶呤(MTX)治疗剖宫产瘢痕妊娠患者的临床疗效及对β-人绒毛膜促性腺激素(human chorionic gonadotropin,β-HCG)水平的影响。方法选取2020年6月至2022年5月郑州大学第一附属医院收治的剖宫产后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)患者100例行回顾性研究,将采用宫腔镜手术治疗的50例作为对照组,采用宫腔镜手术联合超声引导下甲氨蝶呤孕囊内注射治疗的50例作为观察组。记录并比较两组患者疗效、β-HCG水平、围术期指标(术中出血量、月经恢复时间、包块消失时间及住院时间)以及并发症情况。结果观察组总有效率(94.00%)高于对照组(74.00%),差异有统计学意义(P<0.05);治疗前两组β-HCG水平比较,差异无统计学意义(P>0.05),治疗1、3、7、14 d后,观察组β-HCG水平分别是(709.25±68.31)U/L、(420.56±47.25)U/L、(269.94±23.37)U/L及(60.56±5.49)U/L,均低于对照组,差异有统计学意义(P<0.05);观察组治疗后术中出血量(42.01±4.16)mL、月经恢复时间(33.72±10.3)d、包块消失时间(20.46±2.19)和住院时间(15.77±1.81)d均少于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为2.0%,明显低于对照组的10.0%,差异有统计学意义(P<0.05)。结论超声引导下甲氨蝶呤孕囊内注射联合宫腔镜手术治疗CSP效果较好,能改善β-HCG水平,缩短月经恢复时间和住院时间,减少术中出血量,且安全性高。Objective To investigate the clinical efficacy of hysteroscopic surgery combined with intratexial injection of methotrexate(MTX)in the treatment of cicatricial pregnancy and the influence on the level of human chorionic gonadotropin(β-HCG).Methods A retrospective study of 100 patients with cesarean scar pregnancy(CSP)treated in the First Affiliated Hospital of Zhengzhou University from June 2020 to May 2022 was selected,and 50 patients treated with hysteroscopic surgery were selected as the control group.The observation group was 50 cases treated with hysteroscopic surgery combined with ultrasound-guided methotrexate intrafectum injection.The therapeutic effect,β-HCG level,perioperative indexes(intraoperative blood loss,menstrual recovery time,time of mass disappearance and length of hospital stay)and complications were recorded and compared between the two groups.Results The total effective rate of observation group(94.00%)was higher than that of control group(74.00%),and the difference was statistically significant(P<0.05).There was no significant difference inβ-HCG level between the two groups before treatment(P>0.05).After 1,3,7 and 14 days of treatment,theβ-HCG levels in the observation group were(709.25±68.31)U/L,(420.56±47.25)U/L,(269.94±23.37)U/L and(60.56±5.49)U/L,respectively,which were lower than those in the control group,and the difference was statistically significant(P<0.05).After treatment,the intraoperative blood loss in the observation group was(42.01±4.16)ml,the menstrual recovery time(33.72±10.3)d,the time of mass disappearance(20.46±2.19)and the length of hospital stay(15.77±1.81)d were lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence of complications in the observation group was 2.0%,significantly lower than that in the control group(10.0%),and the difference was statistically significant(P<0.05).Conclusion Ultrasound-guided methotrexate intragestational injection combined with hysteroscopic surgery is effective in the

关 键 词：甲氨蝶呤 剖宫产 瘢痕妊娠 宫腔镜手术 

分 类 号：R714[医药卫生—妇产科学]