甲氨蝶呤聯合超聲引導下清宮術治療子宮瘢痕妊娠的效果

胡麗華

摘 要 目的：探討局部注射甲氨蝶呤聯合經陰道超聲引導下清宮術治療子宮瘢痕妊娠的效果。方法：收集2016年7月至2018年4月收治的子宮瘢痕妊娠患者40例，按照治療方案不同分為觀察組20例和對照組20例。對照組采用深部肌肉注射甲氨蝶呤聯合口服米非司酮治療；觀察組采用局部注射甲氨蝶呤聯合經陰道超聲引導下清宮術治療。觀察兩組療效、血HCG下降至正常時間、附件包塊完全吸收時間。結果：觀察組治愈率為90.00%（18/20），高于對照組的50.00%（10/20）（P<0.05）。觀察組血HCG下降至正常時間和附件包塊完全吸收時間分別為（16.34±3.69）d和（42.19±5.87）d，均低于對照組的（31.25±5.64）d和（48.33±8.04）d（P<0.05）。結論：局部注射甲氨蝶呤聯合經陰道超聲引導下清宮術治療，能夠提高子宮瘢痕妊娠的治療效果，縮短血HCG下降至正常的時間、附件包塊完全吸收的時間，應用價值較高。

關鍵詞 子宮瘢痕妊娠；甲氨蝶呤；經陰道超聲引導下清宮術

中圖分類號：R714.46+1 文獻標志碼：A 文章編號：1006-1533（2019）16-0034-03

Effect of methotrexate combined with ultrasound-guided uterine curettage in the treatment of uterine scar pregnancy

HU Lihua（Obstetrics and Gynecology Department of Maternal and Child Health Care Hospital of Xinyu， Jiangxi Province 338025， China）

ABSTRACT Objective： To investigate the effect of local injection of methotrexate combined with transvaginal ultrasoundguided uterine curettage in the treatment of uterine scar pregnancy. Methods： Forty cases of uterine scar pregnancy from July 2016 to April 2018 were collected， and according to the treatment plan， they were divided into an observation group with 20 cases and a control group with 20 cases. The control group was treated with deep intramuscular injection of methotrexate combined with oral mifepristone， and the observation group was treated by local injection of methotrexate combined with transvaginal ultrasound-guided uterine curettage. The curative effect， the time of blood HCG descending to normal， and the complete absorption time of the accessory mass of the two groups were observed. Results： The cure rate of the observation group was 90.00%（18/20）， which was higher than that of the control group 50.00%（10/20）（P<0.05）. The time of blood HCG descending to normal， and the complete absorption time of the accessory mass in the observation group were （16.34±3.69） d and （42.19±5.87） d， respectively， which were lower than those in the control group （31.25±5.64） d and （48.33±8.04） d（P<0.05）. Conclusion： Local injection of methotrexate combined with transvaginal ultrasound-guided uterine curettage can improve the therapeutic effect of uterine scar pregnancy， shorten the time of blood HCG descending to normal， and the time of complete absorption of accessory mass， and the application value is higher.

KEY WORDS uterine scar pregnancy； methotrexate； transvaginal ultrasound-guided uterine curettage

剖宮產后瘢痕妊娠是臨床常見剖宮產并發癥[1]。隨著剖宮產技術的成熟，剖宮產率不斷上升，使剖宮產瘢痕妊娠的發生率不斷增加[2]。子宮瘢痕妊娠會引起子宮破裂陰道大量出血等情況，對患者的生命安全造成嚴重威脅[3]，部分患者需要通過切除子宮來挽救生命。對于子宮瘢痕妊娠患者，采取積極的干預措施，減少危險情況的發生，具有重要意義。本文報道采用局部注射甲氨蝶呤聯合經陰道超聲引導下清宮術治療子宮瘢痕妊娠的效果。