甲氨蝶呤联合超声监视下清宫与甲氨蝶呤、子宫动脉栓塞术联合清宫治疗停经7周内Ⅱ-Ⅲ型CSP的效果对比分析

doi:10.3969/j.issn.1000-8535.2018.04.010

广州医药 ›› 2018, Vol. 49 ›› Issue (4): 39-42.DOI: 10.3969/j.issn.1000-8535.2018.04.010

甲氨蝶呤联合超声监视下清宫与甲氨蝶呤、子宫动脉栓塞术联合清宫治疗停经7周内Ⅱ-Ⅲ型CSP的效果对比分析

周志君, 梁伟国

广州市番禺区何贤纪念医院妇二科 (广州 511400)

收稿日期:2018-02-28 出版日期:2018-07-20 发布日期:2021-11-29

Comparative analysis of effects of methotrexate combined with uterine curettage under ultrasonic monitoring and methotrexate, uterine artery embolization combined with uterine curettage in the treatment of type Ⅱ-Ⅲ CSP within 7 weeks of menopause

ZHOU Zhijun, LIANG Weiguo

Second Department of Gynecology, Hexian Memorial Hospital, Guangzhou 511400, China

Received:2018-02-28 Online:2018-07-20 Published:2021-11-29

摘要/Abstract

摘要： 目的对比分析甲氨蝶呤(methorexate,MTX)联合超声监视下清宫与甲氨蝶呤、子宫动脉栓塞术(uterine artery embolization,UAE)联合清宫治疗停经7周内Ⅱ-Ⅲ型剖宫产瘢痕妊娠(ceasarean scarpregnancy,CSP)的效果。方法回顾性分析我院自2016年1月—2017年12月收治的停经7周内Ⅱ-Ⅲ型CSP患者的临床资料,按随机、平衡、对照原则分别筛选69例MTX+清宫治疗患者作为A组,68例MTX+UAE+清宫治疗患者作为B组,对比两组治疗成功率、一般治疗情况及术后并发症发生率,并统计两组月经周期恢复时间、血β-hCG恢复至正常时间、疤痕妊娠病灶消失时间。结果两组术后恢复良好,术中、术后均未发生不可控制宫腔出血现象,胎囊组织均全部清出,A组术中出血量、子宫切除发生率、发热、术后盆腹腔疼痛及肝功能损伤发生率均低于B组,术后第1天血β-hCG下降超过50%及治疗成功率、住院时间均高于B组,且该组月经周期恢复时间、血β-hCG恢复至正常时间、疤痕妊娠病灶消失时间亦较B组短(P﹤0.05)。结论于停经7周内Ⅱ-Ⅲ型CSP患者而言,行MTX+清宫治疗或可在不增加出血风险基础上避免UAE相关并发症及副反应。

关键词: 甲氨蝶呤, 超声监视下清宫, 子宫动脉栓塞术, 停经7周内Ⅱ-Ⅲ型CSP

Abstract: Objective To comparatively analyze the effects of methotrexate (MTX) combined with uterine curettage under ultrasonic monitoring and MTX, uterine artery embolization (UAE) combined with uterine curettage in the treatment of cesarean scar pregnancy (CSP) within 7 weeks of menopause. Methods The clinical data of patients with type Ⅱ-Ⅲ CSP within 7 weeks of menopause who were admitted to the hospital from January 2016 to December 2017 were analyzed retrospectively. Another 69 cases treated with MTX combined with uterine curettage were selected as group A and 68 cases treated with MTX+UAE+uterine curettage were selected as group B. The success rate of treatment, general situation of treatment and the incidence of adverse reactions were compared between the two groups. The time of menstrual recovery, the recovery time of blood β-hCG and the disappearance time of scar pregnancy lesions were statistically analyzed. Results The two groups recovered well after operation, and there was no uncontrollable uterine bleeding. All fetal sac tissues were cleared. The intraoperative blood loss, hysterectomy rate, incidence rates of fever, postoperative abdominopelvic pain and liver function injury in group A were less/lower than those in group B, The rate of blood β-hCG decreasing more than 50% on the 1st day after operation, the success rate of treatment and hospitalization time of groups A were higher/longer than those of group B, while the time of menstrual recovery, recovery time of blood β-hCG and the disappearance time of scar pregnancy lesions was shorter than that of group B(P<0.05). Conclusion MTX combined with uterine curettage may avoid complications and side effects of UAE in patients with type Ⅱ-Ⅲ CSP within 7 weeks of menopause, without increasing the risk of bleeding.

Key words: Methotrexate, Uterine curettage under ultrasonic monitoring, Uterine artery embolization, Type Ⅱ-Ⅲ CSP within 7 weeks of menopause

周志君, 梁伟国. 甲氨蝶呤联合超声监视下清宫与甲氨蝶呤、子宫动脉栓塞术联合清宫治疗停经7周内Ⅱ-Ⅲ型CSP的效果对比分析[J]. 广州医药, 2018, 49(4): 39-42.

ZHOU Zhijun, LIANG Weiguo. Comparative analysis of effects of methotrexate combined with uterine curettage under ultrasonic monitoring and methotrexate, uterine artery embolization combined with uterine curettage in the treatment of type Ⅱ-Ⅲ CSP within 7 weeks of menopause[J]. Guangzhou Medical Journal, 2018, 49(4): 39-42.

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甲氨蝶呤联合超声监视下清宫与甲氨蝶呤、子宫动脉栓塞术联合清宫治疗停经7周内Ⅱ-Ⅲ型CSP的效果对比分析

Comparative analysis of effects of methotrexate combined with uterine curettage under ultrasonic monitoring and methotrexate, uterine artery embolization combined with uterine curettage in the treatment of type Ⅱ-Ⅲ CSP within 7 weeks of menopause

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