超声介入下聚桂醇联合甲氨蝶呤局部注射治疗高龄剖宫产子宫瘢痕妊娠的临床观察

目的 观察超声介入下聚桂醇联合甲氨蝶呤局部注射用于治疗高龄剖宫产子宫瘢痕妊娠的临床疗效。 方法 以2016年11月—2018年11月金华市中心医院收治的170例高龄子宫瘢痕妊娠(CSP)患者为研究对象,按照随机数字表法分为对照组(85例)和研究组(85例)。研究组予以超声介入下聚桂醇联合甲氨蝶呤局部注射后负压清宫术治疗,对照组予以超声介入下子宫动脉栓塞联合负压清宫术治疗。记录术中出血量、住院时间、β-hCG转阴时间、术后月经恢复时间和排卵恢复时间,检测治疗前后血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)和抗苗勒管激素(AMH)水平,观察不良反应及并发症情况。 结果 2组术中出血量、住院时间和β-hCG转阴时间差异均无统计学意义(均P>0.05);研究组总体治疗费用(5 967.34±384.96)元]显著低于对照组水平(12 236.51±795.02)元,t=-12.985,P<0.001]。研究组术后月经恢复时间(36.82±3.93)d]和排卵恢复时间(96.37±12.84)d]均显著短于对照组水平(40.69±4.31)d、(114.19±15.62)d,t=-4.196、-6.803,均P<0.05]。研究组术后1个月FSH水平显著低于对照组,AMH和E2水平显著高于对照组(t=-3.796~2.972,均P<0.05)。研究组术后近期不良反应及远期并发症总体发生率(12.94%)显著低于对照组水平(27.06%),χ2=5.294,P=0.021。 结论 较子宫动脉栓塞术,超声介入下聚桂醇联合甲氨蝶呤局部注射对于高龄CSP患者卵巢功能影响更小,有利于促进月经和排卵功能恢复,减少术后不良反应及并发症,降低医疗成本。 

Observation on the clinical effect of local injection of lauromacrogol and methotrexate under ultrasound intervention in the treatment of cesarean scar pregnancy in the elderly

Objective To observe the clinical effect of local injection of lauromacrogol and methotrexate under ultrasound intervention in the treatment of cesarean scar pregnancy(CSP) in the elderly. Methods Total 170 elderly patients with CSP were divided into control group(n=85) and research group(n=85) according to random number table method. The patients in the research group were treated by vacuum curettage after local injection of lauromacrogol and methotrexate, while the patients in the control group were treated by uterine artery embolization and vacuum curettage. The amount of intraoperative bleeding, length of stay, time of β-hCG turning negative, time of menstrual recovery and time of ovulation recovery were recorded. The changes of serum FSH, LH, E2 and AMH levels before and after treatment were measured. The adverse reactions and complications were observed. Results There was no significant difference between the two groups in the amount of intraoperative bleeding, the length of stay, the time of β-hCG turning negative and the time of focus disappearance(all P>0.05). The total treatment cost of the research group(5 967.34±384.96)yuan] was significantly lower than that of the control group(12 236.51±795.02)yuan, t=-12.985, P<0.001]. The menstrual recovery time(36.82±3.93)d] and ovulation recovery time(96.37±12.84)d] in the research group were significantly shorter than those in the control group(40.69±4.31)d and(114.19±15.62) d, t=-4.196,-6.803; P<0.001]. The level of FSH in the study group was significantly lower than that in the control group, and the level of AMH and E2 was significantly higher than that in the control group at 1 months after operation(t=-3.796~2.972, all P<0.05). The overall incidence of short-term adverse reactions and long-term complications in the research group(12.94%) was significantly lower than that in the control group(27.06%), χ2=5.294, P=0.021. Conclusion Compared with uterine artery embolization, local injection of lauromacrogol combined with methotrexate under ultrasound intervention has less influence on ovarian function of elderly CSP patients, which is conducive to promoting the recovery of menstruation and ovulation function, reducing postoperative adverse reactions and complications, and reducing medical costs.