三种方法治疗剖宫产术后切口妊娠的临床观察

目的探析三种方法治疗剖宫产术后切口妊娠(cesarean scar pregnancy,CSP)的临床效果和安全性,从住院时间、治愈效果、手术出血量和月经恢复时间等方面进行对比分析。方法回顾性分析2007年1月—2012年6月间本院住院诊断为CSP的患者共30例作为研究对象。将所有患者按照治疗方法分为三组,在口服米非司酮25 mg,2次/d的同时,A组共8例采用甲氨蝶呤联合米非司酮治疗,甲氨蝶呤隔天一次肌内注射,2次/d;B组共10例,采用米非司酮+甲氨蝶呤介入治疗+米索前列醇,使用甲氨蝶呤介入治疗;C组共12例采用甲氨蝶呤联合米非司酮+米索前列醇,隔天一次肌内注射。B组与C组米索前列醇均在清宫术前3~6 h阴道后穹窿放置400~600μg,促进宫颈软化。比较三组患者治疗效果。计量资料采用t检验,P0.05为差异有统计学意义。结果所有患者均好转或痊愈出院。A组住院时间为(31.8±10.3)d、治疗后血β-HCG恢复正常时间为(45.8±11.4)d,B组分别为(7.8±2.4)、(34.2±7.5)d,C组分别为(10.2±5.1)、(35.2±8.4)d,因此A组住院时间和治疗后血β-HCG恢复正常时间最长,与B组、C组相比差异均有统计学意义(均P0.05);B组住院时间最短,与A组、C组相比差异均有统计学意义(均P0.05);术中出血量、月经恢复正常时间差异均无统计学意义(均P0.05)。结论使用米非司酮+甲氨蝶呤介入治疗+米索前列醇治疗CSP的方法临床恢复效果佳且住院时间短,具有临床推广价值。

Clinical observation of cesarean scar pregnancy treated by three different methods

Objective To discuss the clinical efficacy and safety of three different methods in treating cesarean scar pregnancy from the aspects of hospital stay,efficacy,bleeding volume during operation and the time to recovery of menstruation.Methods A retrospective analysis was done on the clinical data of 30 cases of cesarean scar pregnancy in our hospital from January 2007 to June2012.All cases were classified into three groups based on the treatment method.Group A（n=8） received intramuscular injection of methotrexate every other day,combined with mifeprex,25 mg,twice daily.Group B（n=10） received methotrexate（intervention treatment） combined with mifeprex（25mg,twice daily）,and misoprostol 400~600 μg Group C（n=12） received methotrexate combined with mifeprex（25 mg,twice daily） and misoprostol 400~600 μg.Clinical efficacy was compared in the three groups.T-test was used for measurement data,and P0.05 was considered statistically significant.Results All cases were improved or cured and then discharged.The hospital stay was（31.8±10.3） d,（7.8±2.4） d,and（10.2±5.1） d respectively in group A,B and C;the time of bloodβ-HCG to restore normal after treatment was（45.8±11.4）d,（34.2±7.5） d,and（35.2±8.4） d respectively in group A,B and C.Therefore,group A had the longest hospital stay and the time of β-HCG recovery,which showed significant difference from those of group B and group C（P0.05）.Group B had the shortest hospital stay,which showed significant difference from those of group A and group C（P0.05）.There was no difference in intraoperative bleeding and the time to recovery of menstruation between these groups（P0.05）.Conclusion Methotrexate（intervention treatment） combined with mifeprex and misoprostol for cesarean scar pregnancy has better clinical efficacy and shorter hospital stay,which is worthy of clinical application.