经阴道超声介入引导局部注射甲氨蝶呤治疗子宫瘢痕妊娠的临床疗效与安全性分析
|
摘要
目的:探究与分析经阴道介入引导局部注射甲氨蝶呤治疗子宫瘢痕妊娠的临床疗效与安全性。方法:选取我院自2013年1月至2015年1月收治的60例子宫瘢痕妊娠患者,采取随机数字表法分为单次肌肉注射组与经阴道超声介入组,每组各30例,对比两组患者的临床疗效及血HCG下降至正常水平的时间及附件包块完全吸收的时间。结果:单次肌肉注射组治愈率为46.67%,修正后治愈率为53.33%,经阴道超声介入组的治愈率为90.00%,修正后治愈率为93.33%,组间相比均具有显著差异(P<0.05)。单次肌肉注射组血HCG下降至正常水平时间为(30.25±4.68)d、附件包块完全吸收时间为(48.78±7.05)d,经阴道超声介入组血HCG下降至正常水平时间为(16.56±3.57)d、附件包块完全吸收时间为(40.21±5.67)d,组间相比均具有显著差异(P<0.05)。结论:经阴道介入引导局部注射甲氨蝶呤治疗子宫瘢痕妊娠的临床疗效显著,可显著缩短血HCG下降至正常水平及附件包块完全吸收的时间,预后较为良好,安全性较高,值得广泛推广与应用。
Objectives: To explore and analyze the clinical curative effect and safety of transvaginal ultrasound interventional guide local injections of methotrexate in the treatment of uterine scar pregnancy. Methods: 60 patients with uterine scar pregnancy in our hospital from January 2013 to January 2015 were selected and randomlydivided into only muscle injection group and transvaginal ultrasound intervention group,30 cases in each group. The clinical curative effect,the time of blood- HCG dropped to normal level and time of accessory bag piece completely absorbed of the two groups were compared. Results: The cure rate of only muscle injection group was 46. 67%;revised cure rate was 53. 33%. The cure rate of transvaginal ultrasound intervention group was 90. 00%; revised cure rate was 93. 33%. The difference between groups was significant( χ2= 5. 98,P < 0. 05; χ2= 6. 21,P <0. 05). The time of blood- HCG dropped to normal level and time of accessory bag piece completely absorbed in only muscle injection group were( 30. 25 ± 4. 68) d and( 48. 78 ± 7. 05) d,the time of blood- HCG dropped to normal level and time of accessory bag piece completely absorbed in transvaginal ultrasound intervention group were( 16. 56 ± 3. 57) d and( 40. 21 ± 5. 67) d. The difference between groups was significant( t = 3. 45,P <0. 05,t = 0. 05,P < 0. 05). Conclusion: Transvaginal intervention guide local injections of methotrexate in the treatment of uterine scar pregnancy has significant curative effect and can significantly shorten the time of blood HCG dropped to normal levels and accessory bag piece fully absorbed. The prognosis is relatively good,with high security,which is worth popularization and application widely.
Objectives: To explore and analyze the clinical curative effect and safety of transvaginal ultrasound interventional guide local injections of methotrexate in the treatment of uterine scar pregnancy. Methods: 60 patients with uterine scar pregnancy in our hospital from January 2013 to January 2015 were selected and randomlydivided into only muscle injection group and transvaginal ultrasound intervention group,30 cases in each group. The clinical curative effect,the time of blood- HCG dropped to normal level and time of accessory bag piece completely absorbed of the two groups were compared. Results: The cure rate of only muscle injection group was 46. 67%;revised cure rate was 53. 33%. The cure rate of transvaginal ultrasound intervention group was 90. 00%; revised cure rate was 93. 33%. The difference between groups was significant( χ2= 5. 98,P < 0. 05; χ2= 6. 21,P <0. 05). The time of blood- HCG dropped to normal level and time of accessory bag piece completely absorbed in only muscle injection group were( 30. 25 ± 4. 68) d and( 48. 78 ± 7. 05) d,the time of blood- HCG dropped to normal level and time of accessory bag piece completely absorbed in transvaginal ultrasound intervention group were( 16. 56 ± 3. 57) d and( 40. 21 ± 5. 67) d. The difference between groups was significant( t = 3. 45,P <0. 05,t = 0. 05,P < 0. 05). Conclusion: Transvaginal intervention guide local injections of methotrexate in the treatment of uterine scar pregnancy has significant curative effect and can significantly shorten the time of blood HCG dropped to normal levels and accessory bag piece fully absorbed. The prognosis is relatively good,with high security,which is worth popularization and application widely.
引文
[1]乔福元,赵君.瘢痕子宫破裂早期诊断与处理.中国实用妇科与产科杂志,2010,26(8):592-593.
[2]Landon MB.Predicting uterine rupture in women undergoing trial of labor after prior cesarean delivery.Semin Perinatol,2010,12(34):267-271.
[3]梁宝权,郑艾,李春梅.203例剖宫产瘢痕妊娠的临床分析.实用妇产科杂志,2011,27(5):3291-3294.
[4]周晖.宫颈注射甲氨蝶呤与口服米非司酮保守治疗宫外孕疗效对比分析.中国医药指南,2011,9(34):131-132.
[5]邬华萍.妊娠晚期瘢痕子宫破裂26例临床分析.上海预防医学,2011,23(12):651-652.
[6]魏佳.剖宫产术后子宫瘢痕妊娠8例临床分析.中国性科学,2012,21(2):12-13.
[7]吴艳霞,苗蕊,常春.超声介入引导孕囊内注射甲氨蝶呤治疗子宫瘢痕妊娠的临床研究.中国现代医学杂志,2012,22(19):70-72.
[8]马锦霞.瘢痕子宫晚期妊娠不完全破裂10例临床分析.昆明医学院学报,2011,12(9):132-133.
[9]卫素芬,卫玮.甲氨蝶呤治疗异位妊娠的临床观察.中国药物与临床,2010,10(5):572-573.
[10]Askura H,Nakai A,Ishikawa G,et al.Prediction of uterine dehiscence by measuring lower uterine segment thickness prior to the onset of labor:evaluation by transvaginal ultrasonography.J Nippon Med Sch,2000,67(5):352-356.
[11]朱国文.甲氨蝶呤联合米非司酮治疗宫外孕的疗效及安全性评价.亚太传统医药,2011,7(7):88-89.
[12]Nguyen TV,Dinh TV,Suresh MS,et al.Vaginal birth after cesarean section at the University of Texas.J Repord Med,1992,37(10):880-882.
[13]杨晓艳.剖宫产后子宫瘢痕处妊娠的临床处理体会.基层医学论坛,2012,16(25):3321-3322.
[14]Chapman K,Meire H,Chapman R.The value of serial ultrasounds in the management of recurrent uterine scar repture.Br J Obstet Gynecol,1994,101(6):549-551.
[15]Agholor K,Omo-Aghoja L,Okonofua F.Association of antiChlamydia antibodies with ectopic pregnancy in Benin city,Nigeria:a case-control study.Afr Health Sci,2013,13(2):430-440.
[16]徐春慧.剖宫产后子宫瘢痕处妊娠的临床处理.中国实用医药,2013,8(18):106-107.
[17]柏莲芬,张宝换,孙丽梅,等.甲氨蝶呤联合米非司酮保守治疗宫外孕的观察疗效.中外妇儿健康:学术版,2011,19(6):208.
[18]张昌凤.甲氨蝶呤联合米非司酮保守治疗宫外孕52例临床疗效观察.当代医学,2012,18(30):58-59.
[2]Landon MB.Predicting uterine rupture in women undergoing trial of labor after prior cesarean delivery.Semin Perinatol,2010,12(34):267-271.
[3]梁宝权,郑艾,李春梅.203例剖宫产瘢痕妊娠的临床分析.实用妇产科杂志,2011,27(5):3291-3294.
[4]周晖.宫颈注射甲氨蝶呤与口服米非司酮保守治疗宫外孕疗效对比分析.中国医药指南,2011,9(34):131-132.
[5]邬华萍.妊娠晚期瘢痕子宫破裂26例临床分析.上海预防医学,2011,23(12):651-652.
[6]魏佳.剖宫产术后子宫瘢痕妊娠8例临床分析.中国性科学,2012,21(2):12-13.
[7]吴艳霞,苗蕊,常春.超声介入引导孕囊内注射甲氨蝶呤治疗子宫瘢痕妊娠的临床研究.中国现代医学杂志,2012,22(19):70-72.
[8]马锦霞.瘢痕子宫晚期妊娠不完全破裂10例临床分析.昆明医学院学报,2011,12(9):132-133.
[9]卫素芬,卫玮.甲氨蝶呤治疗异位妊娠的临床观察.中国药物与临床,2010,10(5):572-573.
[10]Askura H,Nakai A,Ishikawa G,et al.Prediction of uterine dehiscence by measuring lower uterine segment thickness prior to the onset of labor:evaluation by transvaginal ultrasonography.J Nippon Med Sch,2000,67(5):352-356.
[11]朱国文.甲氨蝶呤联合米非司酮治疗宫外孕的疗效及安全性评价.亚太传统医药,2011,7(7):88-89.
[12]Nguyen TV,Dinh TV,Suresh MS,et al.Vaginal birth after cesarean section at the University of Texas.J Repord Med,1992,37(10):880-882.
[13]杨晓艳.剖宫产后子宫瘢痕处妊娠的临床处理体会.基层医学论坛,2012,16(25):3321-3322.
[14]Chapman K,Meire H,Chapman R.The value of serial ultrasounds in the management of recurrent uterine scar repture.Br J Obstet Gynecol,1994,101(6):549-551.
[15]Agholor K,Omo-Aghoja L,Okonofua F.Association of antiChlamydia antibodies with ectopic pregnancy in Benin city,Nigeria:a case-control study.Afr Health Sci,2013,13(2):430-440.
[16]徐春慧.剖宫产后子宫瘢痕处妊娠的临床处理.中国实用医药,2013,8(18):106-107.
[17]柏莲芬,张宝换,孙丽梅,等.甲氨蝶呤联合米非司酮保守治疗宫外孕的观察疗效.中外妇儿健康:学术版,2011,19(6):208.
[18]张昌凤.甲氨蝶呤联合米非司酮保守治疗宫外孕52例临床疗效观察.当代医学,2012,18(30):58-59.