中药扶正消癥方联合西药或UAE术治疗剖宫产瘢痕妊娠的临床疗效分析
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摘要
目的:比较中药扶正消方联合西药或子宫动脉栓塞术(UAE)治疗剖宫产瘢痕妊娠(CSP)的临床疗效。方法:回顾分析2011年10月~2016年07月期间在我院诊治的39例CSP患者,根据患者在治疗过程中选择治疗手段的不同将所有患者分为观察组和对照组,观察组分为A组和B组,A组采用中药扶正消方联合西药(甲氨蝶呤肌肉注射+米非司酮口服)加清宫术,B组采用中药扶正消方联合UAE加清宫术;对照组则分为C组和D组,C组采用西药加清宫术,D组采用UAE加清宫术,对各组的治疗效果进行比较。结果:介入组(B组和D组)的清宫手术出血量、手术时间、术后血人绒毛膜促性腺激素(β-HCG)转阴时间、包块缩小≥60%时间、住院时间分别优于A组、C组,比较有统计学差异(P<0.05);中药组(A组和B组)的术后血β-HCG转阴时间、包块缩小≥60%时间、住院时间分别优于C组、D组(P<0.05);观察组的治疗成功率(95%)高于对照组(90%),但比较无统计学差异(P>0.05)。结论:中药联合西药或UAE术治疗CSP能够充分发挥中医、西医的优势,取得更好的临床疗效,可在临床上进行推广。
Objective: To analyze the clinical efficacy on cesarean scar pregnancy( CSP) treated by traditional Chinese medicine( TCM) Fuzheng Xiaozheng Formula with western medicine or uterine artery embolization( UAE). Methods: The 39 patients with CSP treated in the hospital from October 2011 to July 2016 were selected and divided into observation group and controlled group according to different ways. The observation group was subdivided into group A and group B,group A was applied to Fuzheng Xiaozheng Formula with intramuscular injection of methotrexate( MTX),oral mifepristone plus curettage,group B was given Fuzheng Xiaozheng Formula with UAE plus curettage. The controlled group was subdivided into group C and group D,group C was treated with MTX,mifepristone plus curettage,while group D was applied to UAE plus curettage. Clinical effect of patients in each group were observed and analyzed. Results: In comparison with A and C,the treatment of interventional therapy group(B and D) could notably reduce the blood loss,the operation time of curettage,the time of blood β-HCG level back to normal,the time of mass reducing 60%,and the duration of hospitalization,with significant difference( P<0. 05). In comparison with C and D,the treatment of Chinese medicine group( A and B) could notably reduce the time of blood β-HCG level back to normal,the time of mass reducing 60%,and the duration of hospitalization,with significant difference( P<0. 05). The controlled group's operative success rate were 90%,the observation group' s were 95%,with no significant difference( P> 0. 05). Conclusion:The clinical effect of TCM Fuzheng Xiaozheng Formula with western medicine or UAE is significant,which can give a full play to the advantages of TCM and western medicine and can be popularized in clinical.
Objective: To analyze the clinical efficacy on cesarean scar pregnancy( CSP) treated by traditional Chinese medicine( TCM) Fuzheng Xiaozheng Formula with western medicine or uterine artery embolization( UAE). Methods: The 39 patients with CSP treated in the hospital from October 2011 to July 2016 were selected and divided into observation group and controlled group according to different ways. The observation group was subdivided into group A and group B,group A was applied to Fuzheng Xiaozheng Formula with intramuscular injection of methotrexate( MTX),oral mifepristone plus curettage,group B was given Fuzheng Xiaozheng Formula with UAE plus curettage. The controlled group was subdivided into group C and group D,group C was treated with MTX,mifepristone plus curettage,while group D was applied to UAE plus curettage. Clinical effect of patients in each group were observed and analyzed. Results: In comparison with A and C,the treatment of interventional therapy group(B and D) could notably reduce the blood loss,the operation time of curettage,the time of blood β-HCG level back to normal,the time of mass reducing 60%,and the duration of hospitalization,with significant difference( P<0. 05). In comparison with C and D,the treatment of Chinese medicine group( A and B) could notably reduce the time of blood β-HCG level back to normal,the time of mass reducing 60%,and the duration of hospitalization,with significant difference( P<0. 05). The controlled group's operative success rate were 90%,the observation group' s were 95%,with no significant difference( P> 0. 05). Conclusion:The clinical effect of TCM Fuzheng Xiaozheng Formula with western medicine or UAE is significant,which can give a full play to the advantages of TCM and western medicine and can be popularized in clinical.
引文
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[10]张艳环.甲氨蝶呤联合米非司酮治疗异位妊娠的临床疗效分析[J].中华全科医学,2013,11(01):12~13
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[12]Sharma C,Soni A,Soni P K,et al.A Retrospective Case-Control Study Evaluating the Role of Mifepristone for Induction of Labor in Women with Previous Cesarean Section[J].J Obstet Gynaecol India,2016,66(Suppl 1):30~37
[13]高植明,何建新.甲氨蝶蛉联合米非司酮治疗异位妊娠45例临床观察[J].中外医疗,2011,(07):7~9
[14]蒋亚玲.中西医结合保守治疗剖宫产术后瘢痕妊娠的疗效观察[J].中西医结合心血管病电子杂志,2016,4(02):169~170
[15]Huang Y,Li Y,Xi R,et al.An application of uterine artery chemoembolization in treating cesarean scar pregnancy[J].Int J Clin Exp Med,2015,8(2):2570~2577
[16]张国福,王添平,谷守欣,等.子宫动脉化疗栓塞在剖宫产切口瘢痕妊娠中的应用研究[J].介入放射学杂志,2010,19(12):936~939
[17]Qiao B,Zhang Z,Li Y.Uterine Artery Embolization Versus Methotrexate for Cesarean Scar Pregnancy in a Chinese Population:A Metaanalysis[J].J Minim Invasive Gynecol,2016
[2]Birge O,Karaca C,Arslan D,et al.Medical management of cesarean scar pregnancy at advanced age:case report and literature review[J].Clin Exp Obstet Gynecol,2016,43(1):140~142
[3]Birch P K,Hoffmann E,Rifbjerg L C,et al.Cesarean scar pregnancy:a systematic review of treatment studies[J].Fertil Steril,2016,105(4):958~967
[4]Ko J K,Li R H,Cheung V Y.Caesarean scar pregnancy:a 10-year experience[J].Aust N Z J Obstet Gynaecol,2015,55(1):64~69
[5]万军,顾伟瑾,王海云,等.双侧子宫动脉化疗栓塞术治疗剖宫产后瘢痕妊娠大出血的临床应用[J].介入放射学杂志,2009,18(07):499~502
[6]Pirjani R,Bayani L,Shirazi M.Successful local and systemic medical treatment of cesarean scar pregnancy and a subsequent term pregnancy after treatment:a case series[J].Iran J Reprod Med,2015,13(7):445~450
[7]田晓曦,张敏.中医联合甲氨蝶呤治疗剖宫产术后瘢痕妊娠的临床疗效[J].中国妇幼保健,2016,31(23):4985~4987
[8]于晨芳,霍西亭,刘艳湘,等.MTX介入或全身用药联合中药口服治疗剖宫产瘢痕妊娠的优越性探讨[J].实用中西医结合临床,2014,14(06):4~6
[9]刘凯杰,李翠兰,莫薛唐,等.剖宫产术后瘢痕妊娠临床诊治进展[J].生殖医学杂志,2016,25(07):660~663
[10]张艳环.甲氨蝶呤联合米非司酮治疗异位妊娠的临床疗效分析[J].中华全科医学,2013,11(01):12~13
[11]Bringley J,Denefrio C,Rijhsinghani A.Twin Cesarean Scar Ectopic Pregnancy Treated with Systemic and Local Methotrexate[J].Am J Obstet Gynecol,2016
[12]Sharma C,Soni A,Soni P K,et al.A Retrospective Case-Control Study Evaluating the Role of Mifepristone for Induction of Labor in Women with Previous Cesarean Section[J].J Obstet Gynaecol India,2016,66(Suppl 1):30~37
[13]高植明,何建新.甲氨蝶蛉联合米非司酮治疗异位妊娠45例临床观察[J].中外医疗,2011,(07):7~9
[14]蒋亚玲.中西医结合保守治疗剖宫产术后瘢痕妊娠的疗效观察[J].中西医结合心血管病电子杂志,2016,4(02):169~170
[15]Huang Y,Li Y,Xi R,et al.An application of uterine artery chemoembolization in treating cesarean scar pregnancy[J].Int J Clin Exp Med,2015,8(2):2570~2577
[16]张国福,王添平,谷守欣,等.子宫动脉化疗栓塞在剖宫产切口瘢痕妊娠中的应用研究[J].介入放射学杂志,2010,19(12):936~939
[17]Qiao B,Zhang Z,Li Y.Uterine Artery Embolization Versus Methotrexate for Cesarean Scar Pregnancy in a Chinese Population:A Metaanalysis[J].J Minim Invasive Gynecol,2016