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目的比较甲氨蝶呤灌注+介入治疗与传统甲氨蝶呤配伍米非司酮治疗剖宫产瘢痕妊娠的临床效果。方法选择2012年1月-2015年3月经术后确诊为剖宫产瘢痕妊娠患者共589例。告知患者2种治疗方案,根据患者自行选择结果进行分组。其中甲组234例,为应患者要求选择传统药物治疗方案:即肌肉注射甲氨蝶呤20 mg,1次/d,共5 d;口服米非司酮50 mg,1次/d,共3~5 d;结合B型超声局部妊娠组织血流情况及患者肝功能决定是否进一步追加用药。乙组255例,为应患者要求选择子宫动脉灌注+介入栓塞术。两组患者年龄、血β-人绒毛膜促性腺激素及宫腔切口处妊娠囊大小差异均无统计学意义(P>0.05)。比较两组治疗效果。结果乙组术中出血量、血β-人绒毛膜促性腺激素降至正常时间、住院时间均少于甲组,差异有统计学意义(P<0.05);乙组重复清宫、重复用药、肝功能受损的发生率均低于甲组,差异有统计学意义(P<0.05);两组子宫切除率差异无统计学意义(P>0.05)。结论在剖宫产瘢痕妊娠治疗方案中,甲氨蝶呤灌注+介入治疗的疗效及安全性均高于传统的甲氨蝶呤配伍米非司酮治疗。
Objective To compare the clinical effects of methotrexate perfusion + interventional therapy with methotrexate in combination with mifepristone in the treatment of cesarean scar pregnancy. Methods A total of 589 pregnant women with cesarean scar pregnancy diagnosed after surgery from January 2012 to March 2015 were selected. Patients were informed of two kinds of treatment options, according to the patient to choose the results of the group. A group of 234 cases, in response to the requirements of patients to choose the traditional drug treatment programs: intramuscular methotrexate 20 mg, 1 / d, a total of 5 d; oral mifepristone 50 mg, 1 / d, a total of 3 ~ 5 d; combined with B-mode ultrasound local pregnancy blood flow and liver function of patients decide whether to add further medication. Group B 255 cases, in response to the request of patients with uterine arterial infusion + interventional embolization. Two groups of patients age, blood β-human chorionic gonadotropin and uterine incision gestational sac size differences were not statistically significant (P> 0.05). Compare the treatment effect of two groups. Results In group B, the amount of blood loss, blood β-human chorionic gonadotropin decreased to normal time and hospital stay was less than that of group A (P <0.05) The incidence of impaired function was lower than that of group A (P <0.05). There was no significant difference in hysterectomy rate between the two groups (P> 0.05). Conclusion The efficacy and safety of methotrexate infusion and interventional therapy in cesarean scar pregnancy treatment are higher than the traditional methotrexate and mifepristone treatment.