中药联合米非司酮及甲氨蝶呤治疗剖宫产后子宫切口妊娠疗效观察.docVIP

中药联合米非司酮及甲氨蝶呤治疗剖宫产后子宫切口妊娠疗效观察【摘 要】 目的 观察中药联合米非司酮和甲氨蝶呤(MTX)治疗剖宫产后子宫切口妊娠的疗效。方法 选择2005年1月至2006年10月间住院的剖宫产术后子宫切口部位早期妊娠患者64例，随机分为A、B两组，每组32例，A组用米非司酮50 mg，每12小时1次，连用5 d，静脉滴注MTX 20 mg/d，连用5 d，中药 (生化汤) 1剂/d，连用5 d。B组联用米非司酮和 MTX，剂量同A组，每周测定血β-HCG判断治疗效果。结果 A组治疗成功率为93．8%，B组成功率为81．2%(P＜0．05)；A组患者血β-HCG下降到正常时间及附件区包块消失时间均较B组短 (P＜0．05)；A组出现恶心呕吐、肝功能损害、血WBC下降例数均较B组少（P＜0．05）。 结论 中药联合米非司酮和甲氨蝶呤(MTX)治疗剖宫产后子宫切口妊娠治愈率高、HCG下降快、附件区包块消失时间及住院时间短，不良反应发生少。 【关键词】 米非司酮；甲氨蝶呤；子宫切口妊娠 Therapeutic effect oftTraditional chinese medicine combined withmethotrexate and mifepriston for cesarean section scarLI Chen-Hui Maternal and Children ′s Health Hospital of HuNan Province,Chang sha 410008，China 【Abstract】 Objective To study the effect of traditional Chinese medicine combined withmethotrexate and mifepriston for cesarean section scar．Methods Group A with 32 cases were treated by combination of traditional Chinese medicine with methotrexate and mifepriston；the dose of which were a dosage×5d，50 mg，Q 12 h×5d；20 mg，Q d×5d.Group B with 32 cases were treated by the same dose of methotrexate and mifepriston．Both groups were put on a same treatment course，the serum β-HCG were monitored every week．Results 93．8% in group A and 81．2% in group B were successfully treated．The decreaseof serum β-HCG and the pack of appendixin group A were faster than group B (P＜0．05)，the side effects of group A were lower than group B，which showed a significant difference （P＜0．05）．Conclusion Traditional Chinese medicine combined withmethotrexate and mifepriston is proved to be moreeffective than the combination of methotrexate with mifepriston in treating cesarean section scar,and has less adverse reaction． 【Key words】 Methotrexate；Mifepriston；Cesarean section scar 剖宫产后切口妊娠(全称子宫下段剖宫产后切口瘢痕处妊娠)是一种罕见的异位妊娠，它是剖宫产的远期并发症之一，本病早期诊断困难[1]，有剖宫产史的妇女，再次妊娠时，胚胎着床在前次子宫切口处，随着妊娠的进展，绒毛与子宫肌层粘连、植入，严重者可穿透子宫造成子宫破裂，导致子宫切除[2]；因其临床表现为停经后阴道流血，常被误诊为难免流产、宫内早孕或输卵管妊娠，从而造成术中大出血。近几年来，随着剖宫产率的增高，此病的发生率也呈上升趋势。但随着异位妊娠早期诊断准确率的不断提高，其药物保守性治疗也日益增多，我院于2005年1月至2006