米非司酮联合米索前列醇终止瘢痕子宫中期妊娠的随机对照研究

目的探讨米非司酮联合米索前列醇终止瘢痕子宫中期妊娠的疗效。方法选择2009年1月至2012年12月河北省易县医院妇产科收治的确诊为瘢痕子宫中期妊娠的孕妇83例,依据随机数字表法分为对照组(n=41,采用米非司酮联合依沙吖啶治疗)和研究组(n=42,采用米非司酮联合米索前列醇治疗),比较两种治疗方式的疗效。结果研究组患者宫缩发动以及排胎时间、阴道出血量、胎盘胎膜残留概率均显著低于对照组(P<0.05);研究组产时宫缩疼痛程度、清宫概率显著低于对照组(P<0.05),且引产成功率高于对照组(100%vs 87.7%,P<0.05);两组均未出现子宫破裂、感染等严重并发症,研究组有胃肠道不良反应2例(4.9%),对照组14例(33.3%),两组比较差异有统计学意义(P<0.05)。结论瘢痕子宫中期妊娠采用米非司酮联合米索前列醇终止治疗疗效更安全可靠,术后清宫率低,值得临床推广。

Randomized Controlled Study of Mifepristone Combined with Misoprostol for Trimester Termination of Uterine Scar

Objective To explore the therapeutic effect of misoprostol combined with mifepristone for interim pregnancy termination of the uterine scar.Methods A total of 83 cases of mid-pregnancy with uterine scar admitted to Yixian Hospital of Hebei from Jan.2009 to Dec.2012 were selected and randomly divided into control group（n =41,mifepristone combined with ethacridine） and study groups（n =42,mifepristone combined with misoprostol）,and the therapeutic efficacy of the two treatments was compared.Results The contractions starting time and delivery time,vaginal bleeding,placenta and membranes residual amount of the study group were all significantly lower than the control group（P 〈 0.05） ; Intrapartum uterine pain and uterine clearance rate of the study group were significantly lower than the control group（P 〈 0.05）,and the success rate of induction of labor was higher than the control group（100% vs 87.7%,P 〈 0.05） ;there were no serious complications such as uterine rupture,infection in either group,the gastrointestinal adverse reactions occurred in 2 cases （4.9%） in the study group,in 14 cases（33.3%） in the control group,and the difference was significant（P 〈 0.05）.Conclusion Mifepristone combined with misoprostol therapy to terminate the interim pregnancy with uterine scar is safer and more reliable with lower postoperative curettage rate,thus is worthy of further promotion in clinical.