子宫动脉栓塞与肌注甲氨蝶呤分别联合清宫术治疗剖宫产术后切口妊娠临床疗效对比分析
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摘要
目的探讨子宫动脉栓塞与肌注甲氨蝶呤分别联合清宫术治疗剖宫产术后切口妊娠临床疗效对比分析。方法回顾性分析2016年10月—2018年2月解放军第260医院收治的82例剖宫产术后切口妊娠患者的临床资料,根据随机数字表法分为观察组和对照组,每组41例。观察组患者采用子宫动脉栓塞结合宫腔镜下清宫术治疗,对照组患者采用肌注甲氨蝶呤联合清宫术治疗,观察并对比2组患者的临床疗效,术中出血量、手术时间、阴道流血时间、住院时间、血绒毛膜促性腺激素(β-HCG)转阴时间及并发症情况和输血情况。结果观察组患者治疗后临床总有效率明显高于对照组(P<0.05);与对照组比较,观察组术中出血量少、阴道流血时间短、住院时间短、血β-HCG转阴时间短,差异具有统计学意义(P<0.05);观察组患者术后并发症发生率明显低于对照组;输血率比较差异有统计学意义(P<0.05)。结论子宫动脉栓塞结合宫腔镜下清宫术治疗剖宫产术后切口妊娠患者临床疗效显著,术后并发症情况少,更有利于术后患者的及时恢复,值得临床推广。
Objective To investigate the clinical effect of uterine artery embolization and methotrexate combined with intramuscular injection respectively in the treatment of incisional pregnancy after cesarean section. Methods Eightytwo patients with cesarean scar pregnancy treated in our hospital between October 2016 and February 2018 were selected as the subjects. The clinical data of all these patients was analyzed retrospectively. These patients were divided into the observation group and control group according to treatment methods, with 41 cases in each group. The patients in the observation group were treated with intramuscular injection of methotrexate combined with curettage. The curative effect of the two groups was observed and compared after operation. The intraoperative bleeding volume, duration of surgery, vaginal bleeding time, length of hospital stay, blood HCG(β-HCG)clearance time, complications and blood transfusion were also compared between the two groups. Results The total clinical efficiency of patients in the observation group after treatment was significantly higher than that of the control group(P<0.05). Compared with the control group, the bleeding volume, vaginal bleeding, hospital stay and blood β-HCG clearance time in the observation group were reduced or shortened significantly(P<0.05). The incidence of postoperative complications of patients in the observation group decreased significantly compared with the control group. The intraoperative blood transfusion rates of patients in the two groups were significantly different(P<0.05). Conclusion Uterine artery embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy has significant clinical effect, fewer postoperative complications, and is more conducive to recovery of patients. It is worthy of popularization in clinical practice.
Objective To investigate the clinical effect of uterine artery embolization and methotrexate combined with intramuscular injection respectively in the treatment of incisional pregnancy after cesarean section. Methods Eightytwo patients with cesarean scar pregnancy treated in our hospital between October 2016 and February 2018 were selected as the subjects. The clinical data of all these patients was analyzed retrospectively. These patients were divided into the observation group and control group according to treatment methods, with 41 cases in each group. The patients in the observation group were treated with intramuscular injection of methotrexate combined with curettage. The curative effect of the two groups was observed and compared after operation. The intraoperative bleeding volume, duration of surgery, vaginal bleeding time, length of hospital stay, blood HCG(β-HCG)clearance time, complications and blood transfusion were also compared between the two groups. Results The total clinical efficiency of patients in the observation group after treatment was significantly higher than that of the control group(P<0.05). Compared with the control group, the bleeding volume, vaginal bleeding, hospital stay and blood β-HCG clearance time in the observation group were reduced or shortened significantly(P<0.05). The incidence of postoperative complications of patients in the observation group decreased significantly compared with the control group. The intraoperative blood transfusion rates of patients in the two groups were significantly different(P<0.05). Conclusion Uterine artery embolization combined with hysteroscopy in the treatment of cesarean scar pregnancy has significant clinical effect, fewer postoperative complications, and is more conducive to recovery of patients. It is worthy of popularization in clinical practice.
引文
[1]熊洁,陈锦云,王熙,等.高强度聚焦超声治疗包块型剖宫产瘢痕妊娠19例临床分析[J].现代妇产科进展,2016,25(6):448-451.
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[8]王金娟,成九梅,张颖,等.宫腹腔镜联合治疗剖宫产切口妊娠37例临床观察[J].北京医学,2015,37(10):956-958.
[9]贾胜楠,洛若愚,皮洁.甲氨蝶呤辅助宫腔镜电切术治疗剖宫产疤痕妊娠的疗效分析[J].中国性科学,2016,25(2):115-117.
[10]倪萍,龙玲,范幸.宫腔镜联合甲氨蝶呤+米非司酮治疗子宫切口妊娠疗效观察[J].中国计划生育和妇产科,2016,8(4):59-61.
[11]刘春燕.不同方法治疗剖宫产术后瘢痕部位妊娠的临床疗效分析[J].四川医学,2016,38(8):885-887.
[12]章晓乐,何培芝,胡春花,等.子宫动脉栓塞化疗后内视镜下孕囊定位吸引术治疗剖宫产切口妊娠临床研究[J].生殖医学杂志,2016,25(10):943-946.
[13]Pomorski M,Fuchs T,Rosner-Tenerowicz A,et al.Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section[J].Ginekol Pol,2017,88(4):174-179.
[14]莫永祥,陈玉堂,高智琴.剖宫产术后切口妊娠的子宫动脉灌注化疗栓塞术联合清宫的疗效分析[J].中华全科医学,2016,14(12):2 144-2 146.
[15]傅其添,游琴章,胡小芹.子宫动脉栓塞术联合灌注甲氨蝶呤治疗疤痕妊娠的临床研究[J].中国辐射卫生,2015,24(6):694-695.
[16]南刚,惠旭东,马晓娟,等.囊胚破坏加甲氨蝶呤孕囊内注射治疗剖宫产术后子宫瘢痕妊娠的临床研究[J].天津医药,2017,45(10):1 061-1 063.
[17]Chen X,Xu Z,Lin R,et al.Persistent cauda equina syndrome after cesarean section under combined spinal-epidural anesthesia:a case report[J].J Clin Anesth,2015,27(6):520-523.
[18]葛俊丽,吕小慧,罗丹霞,等.子宫动脉栓塞联合清宫术治疗子宫瘢痕部位妊娠临床研究[J].山西医科大学学报,2016,47(7):636-639.
[2]修晨.TCSPDS-MN治疗子宫瘢痕妊娠的临床效果[J].中国妇幼保健,2017,32(19):4 782-4 784.
[3]赵丽燕,游向东,胡巨英,等.彩色多普勒超声和超声造影联合在子宫切口妊娠早期诊断中的价值[J].中华急诊医学杂志,2015,24(12):1 473-1 475.
[4]Matsuura A,Yamamoto T,Arakawa T,et al.Management of severe hypertension by nicardipine intravenous infusion in pregnancy induced hypertension after cesarean section[J].Water Res,2015,3(1):28-31.
[5]吉文倩,何娟,刘亚敏.甲氨蝶呤两种给药方式联合清宫术治疗剖宫产瘢痕妊娠的疗效比较[J].中国药房,2017,28(24):3 380-3 383.
[6]张波,张会芳,邱艳.剖宫产术后切口妊娠的诊断与治疗[J].西部医学,2010,22(11):2 048-2 049.
[7]刘丽,刘钰,张虹.子宫动脉灌注甲氨蝶呤栓塞联合清宫术用于剖宫产瘢痕妊娠的疗效[J].国际生殖健康/计划生育杂志,2016,35(6):476-479.
[8]王金娟,成九梅,张颖,等.宫腹腔镜联合治疗剖宫产切口妊娠37例临床观察[J].北京医学,2015,37(10):956-958.
[9]贾胜楠,洛若愚,皮洁.甲氨蝶呤辅助宫腔镜电切术治疗剖宫产疤痕妊娠的疗效分析[J].中国性科学,2016,25(2):115-117.
[10]倪萍,龙玲,范幸.宫腔镜联合甲氨蝶呤+米非司酮治疗子宫切口妊娠疗效观察[J].中国计划生育和妇产科,2016,8(4):59-61.
[11]刘春燕.不同方法治疗剖宫产术后瘢痕部位妊娠的临床疗效分析[J].四川医学,2016,38(8):885-887.
[12]章晓乐,何培芝,胡春花,等.子宫动脉栓塞化疗后内视镜下孕囊定位吸引术治疗剖宫产切口妊娠临床研究[J].生殖医学杂志,2016,25(10):943-946.
[13]Pomorski M,Fuchs T,Rosner-Tenerowicz A,et al.Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section[J].Ginekol Pol,2017,88(4):174-179.
[14]莫永祥,陈玉堂,高智琴.剖宫产术后切口妊娠的子宫动脉灌注化疗栓塞术联合清宫的疗效分析[J].中华全科医学,2016,14(12):2 144-2 146.
[15]傅其添,游琴章,胡小芹.子宫动脉栓塞术联合灌注甲氨蝶呤治疗疤痕妊娠的临床研究[J].中国辐射卫生,2015,24(6):694-695.
[16]南刚,惠旭东,马晓娟,等.囊胚破坏加甲氨蝶呤孕囊内注射治疗剖宫产术后子宫瘢痕妊娠的临床研究[J].天津医药,2017,45(10):1 061-1 063.
[17]Chen X,Xu Z,Lin R,et al.Persistent cauda equina syndrome after cesarean section under combined spinal-epidural anesthesia:a case report[J].J Clin Anesth,2015,27(6):520-523.
[18]葛俊丽,吕小慧,罗丹霞,等.子宫动脉栓塞联合清宫术治疗子宫瘢痕部位妊娠临床研究[J].山西医科大学学报,2016,47(7):636-639.