超声引导下胎盘组织局部注射MTX治疗胎盘植入的临床研究
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摘要
目的：探讨超声引导下局部注射MTX保守治疗胎盘植入的效果，并与其他的保守治疗方法进行比较。
方法：我们对2003-2006年间山东省立医院产科收治的14例胎盘植入患者进行了研究。超声引导下，在植入的胎盘组织中多点局部注射MTX。术后密切观察阴道流血情况和患者HCG的变化。治疗完成后，对治疗效果进行统计分析，并与全身应用MTX治疗和动脉栓塞术治疗效果进行比较。
结果：
1．治疗后14例患者血HCG显著下降，由治疗前的4518.13±6680.59miu／ml降至173.27±242.46miu／ml，且进行t检验P＜0.05。
2．患者胎盘排出方式，10例(71.43％)为自行排出，3例(21.43％)为清宫术清出，1例(7.1％)为宫腔镜电切术取出；胎盘组织的排出时间在4-30天，平均34.57天。术中均无多量出血。
3．患者治疗期间生命体征基本稳定，无晚期出血病例，无宫腔内感染病例，无治疗后输血病例。
4．共行局部注射MTX治疗术21次，14例病例全部治疗成功。其中注射1次者占71.43％(10／14)，注射2次者14.29％(2／14)，注射3次以上者14.29％(2／14)。
5．治疗显效率为92.86％，总体治疗有效率为100％，不良反应的发生率为7.1％。
6．治疗后随访，1例患者再次妊娠分娩；其余患者均月经规律，经量正常。
结论：
一、超声引导下局部注射MTX治疗胎盘植入是一种有效的保守治疗措施，可减少胎盘植入引起的晚期产后出血，配合中药治疗可保留患者的子宫，改善患者的生活质量。
二、超声引导下局部治疗MTX治疗胎盘植入在治疗成功率和不良反应方面都优于全身应用MTX和动脉栓塞术。
三、超声引导下局部注射MTX治疗胎盘植入，操作简单、安全、并发症少，是治疗胎盘植入的一种新方法。
Objective: The aim of the study was to evaluate the efficacy of local injection with MTX for conservative treatment of placenta accerta with ultrasound guidance, and to compare with systemic MTX and selective arteries embolization.
Study Design: In the study we reviewed 14 cases of placenta accreta in Shandong Provincial Hospital between 2003 and 2007. MTX was injected locally in placenta in several points with ultrasound guidance. The changes of serum human chorionic gonadotrophin (HCG) level and the vaginal bleeding was observed closely. And the successful rate of local injection of MTX with ultrasound guidance was compared with systemic MTX and selective arteries embolization.
Results:
All of 14 cases were treated successfully with uterine preserved, and serum HCG level decreased significantly (P<0.05) . Local injection of just single dose MTX for treatment of placenta accerta with ultrasound guidance has a successful rate of 100%(14/14).
Conclusion:
1. Local injection of MTX with ultrasound guidance is effective for treating placenta accreta
2. Local injection of MTX with ultrasound guidance has a higher successful rate and less side effects compared with systemic MTX and selective arteries embolization . 3. Local injection of MTX with ultrasound guidance may be used as a proper choice in treating the patients with placenta accretaAs a new way , especially to woman who wish to preserve fertility.
方法：我们对2003-2006年间山东省立医院产科收治的14例胎盘植入患者进行了研究。超声引导下，在植入的胎盘组织中多点局部注射MTX。术后密切观察阴道流血情况和患者HCG的变化。治疗完成后，对治疗效果进行统计分析，并与全身应用MTX治疗和动脉栓塞术治疗效果进行比较。
结果：
1．治疗后14例患者血HCG显著下降，由治疗前的4518.13±6680.59miu／ml降至173.27±242.46miu／ml，且进行t检验P＜0.05。
2．患者胎盘排出方式，10例(71.43％)为自行排出，3例(21.43％)为清宫术清出，1例(7.1％)为宫腔镜电切术取出；胎盘组织的排出时间在4-30天，平均34.57天。术中均无多量出血。
3．患者治疗期间生命体征基本稳定，无晚期出血病例，无宫腔内感染病例，无治疗后输血病例。
4．共行局部注射MTX治疗术21次，14例病例全部治疗成功。其中注射1次者占71.43％(10／14)，注射2次者14.29％(2／14)，注射3次以上者14.29％(2／14)。
5．治疗显效率为92.86％，总体治疗有效率为100％，不良反应的发生率为7.1％。
6．治疗后随访，1例患者再次妊娠分娩；其余患者均月经规律，经量正常。
结论：
一、超声引导下局部注射MTX治疗胎盘植入是一种有效的保守治疗措施，可减少胎盘植入引起的晚期产后出血，配合中药治疗可保留患者的子宫，改善患者的生活质量。
二、超声引导下局部治疗MTX治疗胎盘植入在治疗成功率和不良反应方面都优于全身应用MTX和动脉栓塞术。
三、超声引导下局部注射MTX治疗胎盘植入，操作简单、安全、并发症少，是治疗胎盘植入的一种新方法。
Objective: The aim of the study was to evaluate the efficacy of local injection with MTX for conservative treatment of placenta accerta with ultrasound guidance, and to compare with systemic MTX and selective arteries embolization.
Study Design: In the study we reviewed 14 cases of placenta accreta in Shandong Provincial Hospital between 2003 and 2007. MTX was injected locally in placenta in several points with ultrasound guidance. The changes of serum human chorionic gonadotrophin (HCG) level and the vaginal bleeding was observed closely. And the successful rate of local injection of MTX with ultrasound guidance was compared with systemic MTX and selective arteries embolization.
Results:
All of 14 cases were treated successfully with uterine preserved, and serum HCG level decreased significantly (P<0.05) . Local injection of just single dose MTX for treatment of placenta accerta with ultrasound guidance has a successful rate of 100%(14/14).
Conclusion:
1. Local injection of MTX with ultrasound guidance is effective for treating placenta accreta
2. Local injection of MTX with ultrasound guidance has a higher successful rate and less side effects compared with systemic MTX and selective arteries embolization . 3. Local injection of MTX with ultrasound guidance may be used as a proper choice in treating the patients with placenta accretaAs a new way , especially to woman who wish to preserve fertility.
引文
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