甲氨蝶呤联合宫腔镜下清宫及球囊压迫治疗剖宫产瘢痕部位妊娠78例临床观察

目的探索更简单、经济、有效且风险相对低、便于更多医疗机构能开展的剖宫产瘢痕部位妊娠（caesarean scar pregnancy，CSP）治疗方法。方法回顾性分析78例北京市海淀区妇幼保健院2010年1月至2013年1月收住的剖宫产瘢痕部位妊娠患者，先用甲氨蝶呤联合米非司酮药物治疗，在血8-hCG呈下降趋势后宫腔镜直视下清除妊娠组织，术后宫腔局部给予Foley双腔尿管球囊压迫，观察治疗的成功率、术中术后出血量、急诊清官率、二次清官率、不良反应发生率，并且比较了甲氨蝶呤不同给药途径治疗效果的差异。结果78例患者100％治疗成功，78．2％（61／78）的患者术中术后出血〈200ml，20％（15／78）行急诊清官，11．5％（9／78）行宫腔镜下二次清官，60．3％（47／78）有球囊压迫，75．6％（59／78）无不良反应。甲氨蝶呤三种不同给药途径的治疗效果无差异。结论药物联合宫腔镜下清宫及球囊压迫治疗剖宫产瘢痕部位妊娠成功率高，疗效可靠，副作用少，便于基层医院推广。

Methotrexate therapy combined with suction curettage under hysteroscopy and Foley tamponade for 78 cases caesarean scar pregnancy

Objective To explore a more simple, effective and economic treatment for caesarean scar pregnancy. Methods A retrospective review of medical records of 78 cases of caesarean scar pregnancy patients admitted in Haidian Maternal ＆Children＇s Hospital from January 2010 to January 2013 was performed, the patients received Methotrexate （MTX） and Milestone therapy first, then suction curettage under hysteroscopy was done when serum human chorionic gonadotropin-beta subunit （β - hCG） decreased. Foley tamponade was used in bleeding cases. The success rate, blood volume during and after curettage, emergency curettage rate, adverse reaction and the second time curettage rate were observed. We also compared the treatment effectiveness of the three different way of MTX administration. Results All patients were treated success, no patient received additional therapy. Blood lost was less that 200 ml in 78.2%（61/78） patients. 20%（15/78） patients underwent emergency curettage. 11.5% （9/78） patients underwent second time curettage. 60. 3% （47/78） used Foley tamponade. 75.6% （59/78） had no adverse reaction. The treatment effectiveness of the three different way of MTX administration had no significant differences. Conclusions Methotrexate therapy combined with suction curettage under hysteroscopy and Foley tamponade is a effective way to treat caesarean scar pregnancy. It can be used in basic hospitals.