腹腔镜结合甲氨蝶呤术前治疗Ⅱ型剖宫产瘢痕妊娠疗效分析.docVIP

腹腔镜结合甲氨蝶呤术前治疗Ⅱ型剖宫产瘢痕妊娠疗效分析 　　【摘要】 目的：探讨剖宫产瘢痕妊娠（Cesarean scar pregnancy，CSP）行腹腔镜保守性手术联合术前使用甲氨蝶呤MTX的可行性及安全性。方法：将笔者所在医院2008年10月-至今收治Ⅱ型剖宫产瘢痕妊娠患者37例分为两组。A组18例术前给予甲氨蝶呤50～75 mg静脉注射，B组19例术前不使用甲氨蝶呤，仅进行腹腔镜下瘢痕处妊娠物清除术。随后对手术前后激素指标、术中出血量、手术时长等参数进行分析。结果：两组患者均保留生育功能治愈出院。A组手术过程中出血量明显低于B组，A组手术时间明显高于B组，两组比较差异均有统计学意义（P0.05）。结论：腹腔镜保守性手术联合甲氨蝶呤治疗Ⅱ型剖宫产瘢痕妊娠具有创伤小、康复快的优点。在腹腔镜下可以对病情进行确诊，在瘢痕处妊娠物清除术的同时，也清除了与宫腔相连的腔隙与窦道，减少了再次发生CSP、胎盘植入的风险，值得推广。 　　【关键词】 腹腔镜手术； 甲氨蝶呤； 剖宫产瘢痕妊娠 　　中图分类号 R714 文献标识码 B 文章编号 1674-6805（2014）26-0014-03 　　【Abstract】 Objective：To evaluate the feasibility and safety of Methotrexate before laparoscopic operation on typeⅡ cesarean scar pregnancy patients.Method：37 typeⅡ cesarean scar pregnancy patients from our hospital were randomly divided into two groups.Group A was intravenous injected 50-75 mg Methotrexate before operation， while group B was solely treated with laparoscopic operation.The parameters of operation result were analyzed with independent samples t-test.Result： Two groups of patients were reserved reproductive function and hospital cured.Compared with group B， bleeding volume during operation of group A were significantly reduced and operation duration of group A were significantly rised（P0.05）.Conclusion：It is effective and micro-traumatic to use of Methotrexate before laparoscopic operation on typeⅡ cesarean scar pregnancy patients.The diagnosis conclusion can be confirmed with laparoscope observation， meanwhile the scar pregnancy and sinus tract connected to uterine cavity can be removed， which reduced the risk of recurrence of cesarean scar pregnancy and placenta accreta.This treatment is worth of popularizing. 　　【Key words】 Laparoscopic operation； Methotrexate； Cesarean scar pregnancy 　　First-author’s address： Kunming City Maternal and Child Health Hospital，Kunming 650000，China 　　剖宫产瘢痕妊娠是妊娠囊植入上次手术瘢痕的一种异位妊娠。在异位妊娠中，这是一种少见并且威胁患者生命的疾病。Seow等[1]报道，该病的发病率在1/2226左右。瘢痕妊娠有大出血、子宫破裂和继发感染等3种严重的并发症。当发生出血性休克危及生命，就需要紧急全子宫切除。很多理论试图解释该疾病的发病机制，其中最合理的就是孕体通过剖宫产瘢痕处微开裂的腔道进入子宫