甲氨蝶呤化疗联合宫腔镜手术电切治疗剖宫产切口瘢痕妊娠的临床研究

目的 探讨甲氨蝶呤化疗联合官腔镜手术电切治疗剖宫产切口妊娠(CSP)临床应用价值.方法 回顾性分析、对比我院收治的22例剖宫产切口妊娠患者,其中采取在甲氨蝶呤化疗杀胚治疗的基础上使用宫腔镜直视下对切口处绒毛组织进行局部电切除的治疗方式设为A组,另外9例剖宫产切口妊娠患者采取在甲氨蝶呤化疗杀胚治疗的基础上床边B超定位下行负压吸引清宫术的治疗方式设为B组,对比两组患者平均停经天数、术前血β-HCG值、术前B超瘢痕处病灶大小、平均手术时间、术中出血量、术后血p-HCG下降至正常的时间以及术后月经恢复时间,进行详细记录分析.结果 两组患者均手术成功,术前情况如平均停经天数、术前血β-HCG值、术前B超瘢痕处病灶大小、平均甲氨蝶呤化疗至可行手术所需时间无明显差异(P＞0.05)；平均手术时间:A组(32.30±10.56)min、B组(51.00±20.63)min,术中出血量:A组(33.84±27.18)mL、B组(82.50±74.35)mL,术后血β-HCG下降至正常的时间:A组(23.69±8.04)d、B组(46.37±16.50)d,月经恢复时间:A组(35.69±6.23)d、B组(56.87±15.07)d,各项指标两组比较差异均有统计学意义(P＜0.05).结论 甲氨蝶呤化疗联合宫腔镜手术电切治疗是治疗剖宫产切口妊娠有效、安全、微创、方便的治疗措施.

Clinical research of methotrexate chemotherapy plus hysteroscopy surgery for cesarean scar pregnancy

Objective To explore the clinical application value of methotrexate chemotherapy plus hysteroscopy surgery for cesarean scar pregnancy （CSP）. Methods Retrospectively analyzed the data of 22 cases of patients with CSP in our hospital,the patients treated with methotrexate chemotherapy and local electricity incision under hysteroseopy to villus tissue resection were set to group A,and another 9 patients treated with methotrexate chemotherapy and negative pressure suction technique under B-ultrasonic localization were set to group B.Compared and analyzed the average menstruation stop time, preoperative blood [3-HCG level, preoperative ultrasound sear size of lesions, average time of operation, intraoperative blood loss, postoperative blood HCG dropped to normal time, and postoperative menstruation recovery time between the two groups. Results All the operations of the two groups were successful,the average menstruation stop time, preoperative blood 13-HCG level, preoperative ultrasound scar size of lesions, and the average time from methotrexate chemotherapy to practicable operation of the two groups were not significant different（P 〉 O.05）.The average operating time of group A was （32.30±10.56） rain,group B was （51.00± 20.63）min;intraoperative blood loss of group A was （33.84±27.18） mL,group B was （82.50±74.35） mL;postoperative blood HCG dropped to normal time of group A was （23.69±8.04） days, group B was （46.37±16.50）days; menstruation recovery time of group A was （35.69±6.23） days, group B was （56.87±15.07） days,there were significant differences between the two groups （P 〈 0.05）. Conclusion Methotrexate chemotherapy plus hysteroscopy surgery is safe,effective, minimally invasive and convenient for the treatment of cesarean scar pregnancy.