超声引导下疤痕子宫切口妊娠囊内注射MTX联合米非司酮口服的疗效探讨.docVIP

超声引导下疤痕子宫切口妊娠囊内注射MTX联合米非司酮口服的疗效探讨 　　[摘要] 目的 探讨超声引导下囊内注射甲氨蝶呤（MTX）联合米非司酮口服治疗疤痕子宫切口妊娠的疗效。 方法 整群选取2013年1月―2015年6月间南通和美家妇产科医院妇产科收治的34例疤痕子宫切口妊娠患者作为研究对象，按数字表示法随机分成观察组和对照组；对照组予以超声引导下囊内注射甲氨蝶呤MTX，对照组在其基础上联合米非司酮口服；比较两组的β-HCG恢复速度、阴道出血量和保守治疗成功率。 结果 两组在1、2周的β-HCG，β-HCG正常时间和阴道出血量比较，t值分别为2.429、2.374、3.718和2.751，差异有统计学意义（P0.05）；在保守治疗成功率比较，χ2值为9.28，差异有统计学意义（P0.05）。 结论 采用超声引导下囊内注射MTX联合米非司酮口服治疗疤痕子宫切口妊娠，能显著加快β-HCG恢复正常，有效终止妊娠，降低手术率。 　　[Abstract] Objective To discuss the curative effect of injection of MTX into cyst combined with oral administration of mifepristone guided by ultrasound in treatment of cesarean scar pregnancy. Methods 34 cases of patients with cesarean scar pregnancy treated in the obstetrics and gynecology department of Nantong Hemeijia Obstetrics and Gynecology Hospital from January 2013 to June 2015 were selected as the research object and randomly divided into two groups， the control group were treated with injection of MTX into cyst guided by ultrasound， the observation group were treated with injection of MTX into cyst and oral administration of mifepristone， the recovery rate of β-HCG， vaginal bleeding volume and success rate of conservative treatment of the two groups were compared. Results The differences in the normal time of β-HCG in the first week and the second week and vaginal bleeding volume between the two groups were obvious （t= 2.429， 2.374， 3.718 and 2.751） （P0.05）， the difference in the success rate of conservative treatment between the two groups was obvious （χ2 = 9.28），（P0.05）. Conclusion Injection of MTX into cyst combined with oral administration of mifepristone guided by ultrasound in treatment of cesarean scar pregnancy can obviously accelerate β-HCG to return to normal， effectively terminate pregnancy and reduce the operative rate. 　　[Key words] Cesarean scar pregnancy； Ultrasound； MTX； Mifepristone； Curative effect 　　异位妊娠是指受精卵在子宫体腔以外部位着床的妊娠，而疤痕子宫切口妊娠是极少见的异位妊娠之一[1]。社会因素和围生医学等发展的影响，剖宫产率一直居高不下，因此疤痕子宫切口妊娠发生率也相应增加。绒毛和孕囊与子宫肌层粘连和植入，可穿透子宫，人工流产和手