超聲引導(dǎo)下妊娠囊內(nèi)注射甲氨蝶呤聯(lián)合宮腔鏡下清宮術(shù)治療剖宮產(chǎn)瘢痕妊娠的臨床應(yīng)用分析

王文雁 白殷 孟萍萍

【摘要】目的：討論剖宮產(chǎn)瘢痕妊娠以超聲引導(dǎo)下妊娠囊內(nèi)注射甲氨蝶呤（Methotrexate，本文簡(jiǎn)稱MTX）+宮腔鏡下清宮術(shù)（Hysteroscopic Curettage，本文簡(jiǎn)稱HC）治療的效果。方法：選取2018年8月—2021年8月我院剖宮產(chǎn)瘢痕妊娠患者30例納入研究，隨機(jī)劃成對(duì)照組與觀察組兩組，各15例。兩組患者皆以注射MTX+HC治療，但具體方式不同，對(duì)照組常規(guī)肌肉注射，觀察組超聲引導(dǎo)囊內(nèi)注射，比較兩組治療效果。結(jié)果：觀察組患者治療總有效率高于對(duì)照組（P<0.05），β-HCG降低、月經(jīng)恢復(fù)、住院等時(shí)間均短于對(duì)照組（P<0.05）。結(jié)論：超聲引導(dǎo)下妊娠囊內(nèi)注射MTX聯(lián)合HC具有良好應(yīng)用價(jià)值，對(duì)剖宮產(chǎn)瘢痕妊娠治療的總有效率高，同時(shí)還有助于患者癥狀的快速恢復(fù)，值得肯定。

【關(guān)鍵詞】超聲引導(dǎo)；妊娠囊內(nèi)注射；甲氨蝶呤；宮腔鏡下清宮術(shù)；剖宮產(chǎn)瘢痕妊娠

Clinical application of ultrasound-guided intracapsular injection of methotrexate combined with hysteroscopic curettage in the treatment of cesarean scar pregnancy

WANG Wenyan， BAI Yin， MENG Pingping

Harbin 242 hospital， Harbin， Heilongjiang 150066， China

【Abstract】Objective：To evaluate the efficacy of ultrasound-guided intracapsular injection of methotrexate （MTX） andhysteroscopiccurettage （HC） in the treatment of cesarean scar pregnancy.Methods：From August 2018 to August 2021，28 cases of cesarean scar pregnancy in our hospital were enrolled in the study and randomly divided into control group and observation group，14 cases in each group. The two groups were treated by injecting MTX + HC， but the specific methods were different.The control group received routine intramuscular injection and the observation group received ultrasound-guided intracapsularinjection，the therapeutic effects of the two groups were compared. Results：The total effective rate of treatment in the observation group was higher than that in the control group（P<0.05）.The time of β-HCG reduction，menstrual recovery and hospitalization in the observation group was shorter than that in the control group（P<0.05）.Conclusion：Ultrasound-guided intracapsular injection of MTX combined with HC has a good application value.It has a high total effective rate in the treatment of cesarean scar pregnancy and is also contribute to the rapid recovery of patients with symptoms，it is worthy of affirmation.

【Key Words】Ultrasound guidance； Intrathecal injection of pregnancy； Methotrexate； Hysteroscopiccurettage； Cesarean scar pregnancy

瘢痕妊娠在臨床中的出現(xiàn)率較高，為剖宮產(chǎn)后常見(jiàn)的異位妊娠類型之一[1]。該瘢痕妊娠的形成，主要因剖宮產(chǎn)后宮頸管創(chuàng)口局部凹陷而妊娠囊存在于剖宮產(chǎn)缺陷位置所致。發(fā)生瘢痕的組織彈性往往不佳，因而還會(huì)引發(fā)諸多的合并疾病，如大出血、子宮破裂等，嚴(yán)重時(shí)甚至還危及患者生命安全[2]。目前，臨床在治療瘢痕妊娠時(shí)往往會(huì)選擇藥物治療、子宮動(dòng)脈栓塞治療或手術(shù)治療，不過(guò)，不同方案所實(shí)施的效果和安全性也不盡相同，均有著一定風(fēng)險(xiǎn)。而在當(dāng)下，超聲引導(dǎo)穿刺技術(shù)不斷成熟，借助此方式可實(shí)現(xiàn)宮腔鏡的有效操作，對(duì)清宮的效果也更佳[3]。鑒于此，本文將從超聲引導(dǎo)方面著手，進(jìn)行剖宮產(chǎn)瘢痕妊娠的治療研究?，F(xiàn)論述如下。

1 資料與方法

1.1 一般資料

選取2018年8月—2021年8月我院剖宮產(chǎn)瘢痕妊娠患者30例納入研究，隨機(jī)劃成對(duì)照組與觀察組兩組。組間資料對(duì)比無(wú)明顯差異（P>0.05），符合研究實(shí)施標(biāo)準(zhǔn)，見(jiàn)表1。

1.2 納入和排除標(biāo)準(zhǔn)