氨甲蝶呤与氟尿嘧啶在介入治疗剖宫产后子宫切口妊娠中的疗效对比

目的比较剖宫产后切口妊娠介入治疗中氨甲蝶呤(MTX)和5-氟尿嘧啶(5-FU)的疗效。方法将2007年至2010年收治的92例剖宫产后子宫切口妊娠患者随机分成两组,MTX组46例,给予MTX 60～200 mg子宫动脉内灌注和灌注后栓塞;5-FU组46例,给予5-FU 1 000～1 250 mg子宫动脉内灌注和灌注后栓塞,比较两种药物对剖宫产后切口妊娠的疗效。介入术后第1、2、3天连续复查患者血β人绒毛膜促性腺激素(β-hCG)和孕酮,并随访3个月。结果 MTX组痊愈率97.2%,5-FU组痊愈率100%,两组间疗效差异无统计学意义(P>0.05)。在MTX组和5-FU组,分别有40例和38例第1～3天血β-hCG和孕酮水平迅速下降,下降幅度为50%～80%,两组间差异无统计学意义(P>0.05)。两组患者均于手术当日出现腹痛,MTX组和5-FU组分别有3例和2例术后出现轻度恶心、呕吐,两组间差异无统计学意义(P>0.05)。术后随访中,两组月经恢复时间、激素水平无显著差别。结论两种药物在剖宫产后切口妊娠介入治疗中的疗效相似。

The clinical efficacy of methotrexate and 5-fluorouracil in the interventional treatment of uterine incisional pregnancy after cesarean section: a comparative study

Objective To compare the interventional therapeutic efficacy of methotrexate(MTX) with that of 5-fluorouracil(5-FU)in treating uterine incisional pregnancy after cesarean section.Methods A total of 92 patients with uterine incisional pregnancy after cesarean section,who were admitted to the hospital during the period from 2007 to 2010,were randomly divided into two groups: group MTX and group 5-FU.Patients in group MTX(n = 46) received intra-arterial infusion of MTX(60-200)mg,which was followed by arterial embolization.Patients in group 5-FU(n = 46) received intra-arterial infusion of 5-FU(1 000-1 250)mg,which was followed by arterial embolization.After the treatment the serum β-HCG and progesterone levels were determined daily for three succeeding days.The patients were followed up for three months.The clinical results were compared between the two groups.Results The cure rates in group MTX and group 5-FU were 97.2% and 100%,respectively.No significant difference in cure rate existed between the two groups(P > 0.05).A rapid fall in the serum β-HCG and progesterone levels within 1-3 days after the treatment were detected in 40 cases of group MTX and 38 cases of group 5-FU,and the decreasing extent was over 50%-80%,but the difference between the two groups was not significant(P > 0.05).At the operation day,all patients of both groups had abdominal pain,and three patients in group MTX and 2 patients in 5-FU group had nausea and vomiting,but the difference between the two groups was not significant(P > 0.05).During the follow-up period,no significant difference in the recovery time of the mental cycle and the hormone levels were found between the two groups(P > 0.05).Conclusion For the interventional treatment of uterine incisional pregnancy after cesarean section,the use of MTX has the same clinical efficacy as the use of 5-FU does.