子宫疤痕妊娠经介入后再清宫对比MTX杀胚治疗
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摘要
目的 对比与分析子宫疤痕妊娠者经介入后再清宫治疗与MTX杀胚治疗方法的临床效果。方法 选取自2015年1月11日起至2018年5月23日于我院接受治疗的子宫疤痕妊娠患者35例,其中选取13例行介入后再清宫治疗;3例行直接清宫治疗;5例行米非司酮+米索前列醇后清宫治疗;11例行MTX后再清宫治疗;另有3例疤痕妊娠患者因个人因素转院,放弃该项研究。对比4组患者临床治疗效果及预后情况。结果 介入后再清宫组中,患者术后未出现明显不良反应。直接清宫组中,出现1例清宫后出血,给予宫腔气囊压迫止血;1例术中实施经腹切除疤痕病灶+血管结扎。米非司酮+米索前列醇+清宫组中,有2例同时行子宫动脉下行支结扎,术后出现1例清宫后出血,给予宫腔气囊压迫止血。MTX后再清宫治疗组中,术后出现1例大出血,给予介入治疗;1例术中切除子宫;2例术中实施经腹疤痕病灶切除+血管结扎;2例行子宫动脉下行支结扎治疗。4组组间对比,介入后再清宫组术中出血量最低、β-HCG转阴时间最短、HCG恢复正常用时最短、瘢痕处包块消失时间最短,月经最快恢复,其次为MTX后再清宫治疗组、米非司酮+米索前列醇+清宫组,最后为直接清宫组;在医疗费用上,介入后再清宫组最高,其次为MTX后再清宫治疗组、米非司酮+米索前列醇+清宫组,最后为直接清宫组,差异有统计学意义(P<0.05)。结论 子宫疤痕妊娠经介入后再清宫治疗效果明显优于MTX后再清宫治疗,且预后效果较优。
Objective To compare and analyze the clinical efficacy of uterine curettage after intervention the MTX embryo-killing treatment for uterine scar pregnancy.Methods Thirty-five patients with uterine scar pregnancy who treated in our hospital from January 11, 2015 to May 23, 2018 were selected, of which, 13 cases were treated with uterine curettage after intervention(group A), 3 cases were treated with uterine curettage(group B), 5 cases were treated with uterine curettage after mifepristone + misoprostol(group C), 11 cases were treated with MTX embryo-killing treatment(group D), and another 3 cases of scar pregnancy patients were transferred to other hospital due to personal factors, and the study was abandoned. The clinical treatment effect and prognosis of the four groups of patients were compared.Results In group A, there was no obvious adverse reaction during surgery. In group B, 1 case had post-uterine hemorrhage, and hemorrhage was given by intrauterine balloon compression, and another 1 case was treated with transabdominal scar lesion + vascular ligation. In group C, there were 2 cases of uterine artery ligation during surgery, 1 case had post-uterine hemorrhage, and hemorrhage was given by intrauterine balloon compression. In group D, 1 case of massive hemorrhage occurred after operation, and was treated with interventional therapy, 1 case underwent intraoperative removal of the uterus, 2 cases underwent transabdominal scar resection and vascular ligation, 2 cases underwent uterine curettage and uterine artery ligation. Compared among four groups, group A has the lowest intraoperative blood loss, the shortest β-HCG conversion time, the shortest time for HCG to return to normal, the shortest time of scar disappeared, and the fastest menstruation recovery, followed by the group D, group C, and finally group B; In terms of medical coxt, group A had the highest medical cost, followed by group D, group C and group B, and the differences were statistically significant(P<0.05).Conclusions The effect of uterine curettage after intervention for the treatment of uterine scar pregnancy is significantly better than MTX embryo-killing treatment, and has better prognosis effect.
Objective To compare and analyze the clinical efficacy of uterine curettage after intervention the MTX embryo-killing treatment for uterine scar pregnancy.Methods Thirty-five patients with uterine scar pregnancy who treated in our hospital from January 11, 2015 to May 23, 2018 were selected, of which, 13 cases were treated with uterine curettage after intervention(group A), 3 cases were treated with uterine curettage(group B), 5 cases were treated with uterine curettage after mifepristone + misoprostol(group C), 11 cases were treated with MTX embryo-killing treatment(group D), and another 3 cases of scar pregnancy patients were transferred to other hospital due to personal factors, and the study was abandoned. The clinical treatment effect and prognosis of the four groups of patients were compared.Results In group A, there was no obvious adverse reaction during surgery. In group B, 1 case had post-uterine hemorrhage, and hemorrhage was given by intrauterine balloon compression, and another 1 case was treated with transabdominal scar lesion + vascular ligation. In group C, there were 2 cases of uterine artery ligation during surgery, 1 case had post-uterine hemorrhage, and hemorrhage was given by intrauterine balloon compression. In group D, 1 case of massive hemorrhage occurred after operation, and was treated with interventional therapy, 1 case underwent intraoperative removal of the uterus, 2 cases underwent transabdominal scar resection and vascular ligation, 2 cases underwent uterine curettage and uterine artery ligation. Compared among four groups, group A has the lowest intraoperative blood loss, the shortest β-HCG conversion time, the shortest time for HCG to return to normal, the shortest time of scar disappeared, and the fastest menstruation recovery, followed by the group D, group C, and finally group B; In terms of medical coxt, group A had the highest medical cost, followed by group D, group C and group B, and the differences were statistically significant(P<0.05).Conclusions The effect of uterine curettage after intervention for the treatment of uterine scar pregnancy is significantly better than MTX embryo-killing treatment, and has better prognosis effect.
引文
[1] 杨锦玲,戴志京,严循成.疤痕妊娠行子宫动脉栓塞术的介入治疗与护理[J].实用临床医药杂志,2016,20(12):188-189,196.
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[8] 沈婕红,朱玉胜,徐桂影,等.子宫动脉栓塞术后不同时间行清宫术治疗疤痕妊娠的对比研究[J].中华全科医学,2017,15(8):1 368-1 370.
[9] Polat I,Ekiz A,Acar DK,et al.Suction curettage as first line treatment in cases with cesarean scar pregnancy:feasibility and effectiveness in early pregnancy[J].J Matern Fetal Neonatal Med,2016,29(7):1 066-1 071.
[10] 赵现立,谭宏伟,俞春芝,等.剖宫产瘢痕处妊娠60例不同治疗方法临床研究[J].陕西医学杂志,2018,47(5):568,570.
[11] 陈欢,洛若愚,陈晓琦,等.剖宫产疤痕妊娠的诊断及介入治疗的研究进展[J].中国性科学,2018,27(1):88,91.
[12] 王谋云.中药杀胚Ⅰ号方联合甲氨蝶呤治疗剖宫产瘢痕部位妊娠的临床疗效观察[J].安徽医药,2016,20(8):1 584-1 587.
[13] Birch Petersen K,Hoffmann E,Rifberg Larsen C,et al.Cesarean scar pregnancy:a systematic review of treatment studies[J].Fertil Steril,2016,105(4):958-967.
[14] 陶春梅,王玉玲,郑玉华,等.不同类型子宫疤痕妊娠处理的临床疗效分析[J].中国妇幼健康研究,2018,29(7):936-939.
[15] 杨树环,王志毅,刘丽萍,等.经阴道子宫疤痕妊娠病灶清除与子宫动脉介入栓塞治疗剖宫产瘢痕妊娠的对比研究[J].西部医学,2018,30(5):664-667.
[2] 孙亚峰.腹式子宫疤痕妊娠切除术治疗子宫疤痕妊娠的围手术期护理[J].转化医学电子杂志,2016,3(3):81-82.
[3] Shokeir T.Methotrexate treatment for cesarean scar ectopic pregnancy:learning lessons[J].J Minim Invasive Gynecol,2015,22(6):1 116.
[4] 刘霄.剖宫产子宫疤痕处妊娠32例诊治分析[J].转化医学电子杂志,2015,2(4):44-45.
[5] 王玉楣,王海云,万军.5-Fu子宫动脉化疗栓塞术联合清宫术治疗27例剖宫产术后子宫瘢痕妊娠的临床观察[J].现代医学,2016,44(3):361-364.
[6] Cheung VYT.Local Methotrexate Injection as the First Iine Treatment for Cesarean Scar Pregnancy:Review of the Literature[J].J Minim Invasive Gynecol,2015,22(5):753-753.
[7] 陈雪莲,钱沁佳.剖宫产术后子宫瘢痕妊娠清宫术预后的影响因素分析[J].海南医学,2017,28(9):1 516-1 518.
[8] 沈婕红,朱玉胜,徐桂影,等.子宫动脉栓塞术后不同时间行清宫术治疗疤痕妊娠的对比研究[J].中华全科医学,2017,15(8):1 368-1 370.
[9] Polat I,Ekiz A,Acar DK,et al.Suction curettage as first line treatment in cases with cesarean scar pregnancy:feasibility and effectiveness in early pregnancy[J].J Matern Fetal Neonatal Med,2016,29(7):1 066-1 071.
[10] 赵现立,谭宏伟,俞春芝,等.剖宫产瘢痕处妊娠60例不同治疗方法临床研究[J].陕西医学杂志,2018,47(5):568,570.
[11] 陈欢,洛若愚,陈晓琦,等.剖宫产疤痕妊娠的诊断及介入治疗的研究进展[J].中国性科学,2018,27(1):88,91.
[12] 王谋云.中药杀胚Ⅰ号方联合甲氨蝶呤治疗剖宫产瘢痕部位妊娠的临床疗效观察[J].安徽医药,2016,20(8):1 584-1 587.
[13] Birch Petersen K,Hoffmann E,Rifberg Larsen C,et al.Cesarean scar pregnancy:a systematic review of treatment studies[J].Fertil Steril,2016,105(4):958-967.
[14] 陶春梅,王玉玲,郑玉华,等.不同类型子宫疤痕妊娠处理的临床疗效分析[J].中国妇幼健康研究,2018,29(7):936-939.
[15] 杨树环,王志毅,刘丽萍,等.经阴道子宫疤痕妊娠病灶清除与子宫动脉介入栓塞治疗剖宫产瘢痕妊娠的对比研究[J].西部医学,2018,30(5):664-667.