宫腔镜病灶切除术联合药物治疗子宫瘢痕妊娠的临床分析

目的 探讨宫腔镜病灶切除术联合甲氨蝶呤（MTX）、米非司酮在治疗剖宫产术后子宫瘢痕妊娠（CSP）中的临床疗效.方法 回顾性分析2009年10月到2013年10月期间收治的32例经阴道彩超确诊为早期CSP患者,按照治疗方法的不同随机平均分为两组.A组为对照组,采用MTX囊内注射,联合米非司酮口服,1周后在B超监测下行清宫术;B组为实验组,采用MTX囊内注射,联合米非司酮口服治疗,1周后在B超监测下行宫腔镜病灶切除术＋清宫术＋ MTX病灶注射.对比两组病人治疗后阴道流血量、血β-HCG下降情况及正常月经来潮时间,比较两组的疗效.结果 治疗后1周两组血β-HCG均明显下降,达到50％以上,但B组下降幅度比A组明显;B组血β-HCG下降到正常的时间（14.0±5.1）天及正常月经来潮时间（30.0±4.4）天均比A组短,无一例并发症出现.结论 宫腔镜病灶切除术联合MTX治疗CSP较单独使用药物＋普通清宫术效果更好.

Clinical analysis on hysteroscopic resection of lesions combined with medications for cesarean scar pregnancy

Objective To explore the clinical efficacy of hysteroscopic resection of lesions combined with methotrexate （MTX） and mifepristone in the treatment of cesarean scar pregnancy （CSP）.Methods 32 women with early CSP diagnosed by transvaginal color Doppler ultrasound who had been treated in our hospital during from October 2009 to October 2013 were retrospectively analyzed.The women were randomly divided into two groups according to different therapies.Group A （control group） received dilatation and curettage under type B-ultrasonic monitoring one week after treatment with intracapsular infusions of MTX combined with oral mifepristone; whereas group B （study group） received hysteroscopic resection of lesions plus dilatation and curettage and intralesional injections under ultrasonic monitoring one week following therapies with intracapsular infusions of MTX combined with oral mifepristone.The amount of vaginal bleeding and the decrease in blood B-HCG after treatment,time to onset of the menstrual cycle,and efficacy of therapies were compared between the two groups.Results One week after treatment,B-HCG level was markedly declined in both groups,which was more than 50％ of the baseline.The percentage of B-HCG decrease was significantly greater,and time to return of B-HCG to normal level and to return of a normal menstrual cycle was shorter in group B （14.0 ± 5.1） days and （30.00 ± 4.40）days] than in those in group A.No complications occurred.Conclusions Hysteroscopic resection of lesions combined with methotrexate is more effective than medication alone in the treatment of cesarean scar pregnancy.