米非司酮、局部注射甲氨蝶呤聯合可視人流吸宮及Foley導尿管壓迫止血保守治療剖宮產瘢痕妊娠的臨床研究

黃碧瑗+吳蘭+李婷

【摘要】 目的 探究米非司酮、局部注射甲氨蝶呤聯合可視人工流產（人流）吸宮及Foley導尿管壓迫止血保守治療剖宮產瘢痕妊娠（CSP）的臨床效果。方法 46例剖宮產瘢痕妊娠患者， 根據治療方案的不同分為治療組和對照組， 各23例。對照組患者予以米非司酮口服、甲氨蝶呤肌內注射， 之后在可視人流機下行吸宮術；治療組予以米非司酮片口服， 同時在B超介導下行孕囊內注射甲氨蝶呤， 吸宮術后常規用Foley導尿管球囊置宮腔局部壓迫。比較在用藥8 h后兩組患者孕囊活性和用藥后4 d、1周及2周時患者血清人絨毛膜促性腺激素（β-HCG）值及血β-HCG轉陰時間， 并對此患者術中、術后24 h陰道出血量及平均住院時間。結果 治療組患者用藥后4 d、1周、2周的血β-HCG值及β-HCG轉陰時間均明顯少于對照組， 差異均有統計學意義（P<0.05）。治療組患者用藥后孕囊活性降低率為52.2%及治療成功率為100.0%， 均高于對照組的17.4%和82.6%， 差異均有統計學意義（P<0.05）。治療組患者的術中、術后24 h陰道出血量及住院時間均明顯少于對照組， 差異均有統計學意義（P<0.05）。結論 米非司酮、局部注射甲氨蝶呤聯合可視人流吸宮及Foley導尿管壓迫止血保守治療剖宮產瘢痕妊娠臨床效果顯著， 既能縮短保守治療時間， 又能降低清宮時出血風險， 值得臨床推廣。

【關鍵詞】 剖宮產瘢痕妊娠；米非司酮；甲氨蝶呤；吸宮；Foley導尿管

DOI：10.14163/j.cnki.11-5547/r.2017.08.009

【Abstract】 Objective To explore the clinical effect of mifepristone， methotrexate local injection combined with visible abortion uterine aspiration and Foley catheter compressing hemostasis in conservative treatment of cesarean scar pregnancy （CSP）. Methods A total of 46 cesarean scar pregnancy patients were divided by treatment regimens into treatment group and control group， with 23 cases in each group. The control group received oral mifepristone， intramuscular injection of methotrexate and then uterine aspiration by visual abortion machine， and the treatment group received oral mifepristone， fertilized egg injection of methotrexate guided by B-mode ultrasonography， and Foley catheter compressing hemostasis after uterine aspiration. Comparison were made on fertilized egg activity after 8 h of meditation， serum β subunit of human chorionic gonadotropin （β-HCG） value and blood β-HCG negative conversion time after 4 d， 1 and 2 week of meditation， intraoperative and postoperative vaginal bleeding volume in 24 h and average hospital stay time in two groups. Results The treatment group had less blood β-HCG value and β-HCG negative conversion time after 4 d， 1 and 2 week of meditation than the control group， and their difference had statistical significance （P<0.05）. The treatment group had fertilized egg activity reducing rate as 52.2%， treatment success rate as 100.0%， which were all higher than 17.4% and 82.6% in the control group， and their difference had statistical significance （P<0.05）. The treatment group had less intraoperative and postoperative vaginal bleeding volume in 24 h and hospital stay time than the control group， and their difference had statistical significance （P<0.05）. Conclusion Combination of mifepristone， methotrexate local injection and visible abortion uterine aspiration， Foley catheter compressing hemostasis shows significant clinical effect in conservative treatment of cesarean scar pregnancy， and it can not only shorten conservative treatment time， but also reduce bleeding risk in complete curettage of uterine cavity. So it is worth clinical promotion.