宫腔镜电切术联合宫外孕Ⅱ号方及甲氨蝶呤治疗剖宫产瘢痕妊娠的观察
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摘要
目的:探讨宫腔镜电切术联合宫外孕Ⅱ号方及甲氨蝶呤治疗剖宫产瘢痕妊娠的有效性及安全性。方法:选取我院收治的80例符合纳入标准的剖宫产瘢痕妊娠患者为研究对象,按照其治疗方式不同,分为观察组和对照组,各40例。对照组使用甲氨蝶呤50 mg/m~2,肌注一次;观察组在对照组的基础上加用宫外孕Ⅱ号方饮片,水煎100mL,每日一剂,分两次饭后温服,连用7天。两组均经过药物预处理后,第8天行宫腔镜电切术。术后给予常规治疗,观察组继续服用宫外孕Ⅱ号方直至血人绒毛膜促性腺激素(β-HCG)值降至正常。分析两组的一般资料,观察两组患者的临床疗效,治疗前及治疗后第4、7、11天血β-HCG水平;治疗前及治疗后第7天妊娠包块大小变化;治疗后血β-HCG恢复时间、阴道流血时间及不良反应等相关指标,评估治疗的有效性及安全性。结果:经过药物预处理后进行宫腔镜电切术,治疗后第4、7、11天两组血β-HCG水平均显著低于同组治疗前,随治疗时间延长逐渐降低,且观察组低于对照组,差异均有统计学意义(P<0.05或P<0.01)。使用不同的药物预处理后,第7天测量观察组的妊娠包块大小明显小于对照组。与对照组相比,术后血β-HCG恢复时间、阴道流血时间均明显减少。观察组不良反应的总发生率为5%,远低于对照组的总发生率20%。结论:宫腔镜电切术联合宫外孕Ⅱ号方及甲氨蝶呤治疗剖宫产瘢痕妊娠具有确切的临床疗效,可控制术中出血量,减少副作用,避免介入治疗引起的宫腔粘连、感染等副作用,减轻患者身心及经济负担,值得临床推广运用。
Objective:To explore the effectiveness and safety about the treatment of caesarean scar pregnancy combined hysteroscopic surgery with extopic pregnancyⅡdecoction and methotrexate(MTX).Methods:The 80 cases of cesarean scar pregnancy patients admitted by our hospital from January 2014 to March 2017 were selected as the subjects.According to the treatment way,the patients were divided into experimental group(n=40)and control group(n=40).The control group was given MTX 50 mg/m2 im.once;and the experimental group was given extopic pregnancyⅡdecoction on the basis of the treatment given to the control group;both groups underwent pretreatment with drugs and received hysteroscopic surgery on the 8 th day.Routine treatment was given after surgery.Experimental group continued to take extopic pregnancyⅡdecoction until monitoring the serum beta-hcg level drops below normal.The general information and curative effect,HCG levels before and after4,7 and 11 dof treatment;mass diameter before and after 11 dof treatment,menstruation recovery time and the incidence of adverse reactions in 2 groups were observed.Results:After hysteroscopic surgery pretreatment with extopic pregnancy Ⅱdecoction and MTX,HCG levels after 4,7 and 11 dwere significantly lower than before,it gradually reduced by time prolonged,and research group was lower than control group,the differences were statistically significant(P<0.05 or P<0.01).After treatment with different drugs,the size of pregnancy package in the observation group was significantly smaller than that in the control group.Compared with the control group,the he package block size,beta HCG time and vaginal bleeding time were significantly reduced.Conclusion:It has significant clinical effect of hysteroscopic surgery combined with ectopic pregnancy II and MTX in the treatment of CSP.It has worthy of clinical promotion to control the amount of blood,avoid intrauterine adhesion caused by uterine artery embolization and infection,et al.and reduce burden of the physical and economic of patients.
Objective:To explore the effectiveness and safety about the treatment of caesarean scar pregnancy combined hysteroscopic surgery with extopic pregnancyⅡdecoction and methotrexate(MTX).Methods:The 80 cases of cesarean scar pregnancy patients admitted by our hospital from January 2014 to March 2017 were selected as the subjects.According to the treatment way,the patients were divided into experimental group(n=40)and control group(n=40).The control group was given MTX 50 mg/m2 im.once;and the experimental group was given extopic pregnancyⅡdecoction on the basis of the treatment given to the control group;both groups underwent pretreatment with drugs and received hysteroscopic surgery on the 8 th day.Routine treatment was given after surgery.Experimental group continued to take extopic pregnancyⅡdecoction until monitoring the serum beta-hcg level drops below normal.The general information and curative effect,HCG levels before and after4,7 and 11 dof treatment;mass diameter before and after 11 dof treatment,menstruation recovery time and the incidence of adverse reactions in 2 groups were observed.Results:After hysteroscopic surgery pretreatment with extopic pregnancy Ⅱdecoction and MTX,HCG levels after 4,7 and 11 dwere significantly lower than before,it gradually reduced by time prolonged,and research group was lower than control group,the differences were statistically significant(P<0.05 or P<0.01).After treatment with different drugs,the size of pregnancy package in the observation group was significantly smaller than that in the control group.Compared with the control group,the he package block size,beta HCG time and vaginal bleeding time were significantly reduced.Conclusion:It has significant clinical effect of hysteroscopic surgery combined with ectopic pregnancy II and MTX in the treatment of CSP.It has worthy of clinical promotion to control the amount of blood,avoid intrauterine adhesion caused by uterine artery embolization and infection,et al.and reduce burden of the physical and economic of patients.
引文
1中华医学会计划生育学分会剖宫产瘢痕妊娠诊断与治疗共识[J].中华医学杂志,2016,51(8):568.
2 蔡有芹,张昕蕾,张军.腹腔镜间断褥式内翻缝合法治疗Ⅱ型剖宫产瘢痕妊娠15例[J].中国微创外科杂志,2016,16(11):987-989.
3 Emmanouil K,Ioannis B,Konstantinos P,et al.Novel medical therapy of cesarean scar pregnancy with a viable embryo combining multidose methotrexate and mifepristone a case report[J].Medi-cine,2015,94(41):e1697.
4 谭明华,赵军,耿兮溪,等.不同术式联合治疗复杂剖宫产瘢痕妊娠的效果[J].中国医药,2016,11(5):724-728.
5 连成瑛,陈秀娟,林元,等.224例剖宫产术后子宫疤痕妊娠不同治疗方法的临床疗效分析[J].现代妇产科进展,2016,25(8):603-607.
6 Nautiyal D,Mukherjee K,Perhar I,et al.Comparative study of misoprostol in first and second trimester abortions by oral,sublingual,and vaginal routes[J].J Obstet Gynaecol India,2015,65(4):246-250.
7 魏玉梅,杨慧霞.巨大儿发生率和剖宫产率的变化趋势及其影响因素分析[J].中华妇产科杂志,2015,22(3):170-176.
8 周应芳,杨慧霞.重视剖宫产术后子宫瘢痕妊娠的预防和处置[J].中华妇产科杂志,2014,49(1):3-5.
9 王丽,郭翠荣,胡婠婧,等.经腹、经阴道彩色多普勒超声和腔内探头经腹超声对剖宫产瘢痕妊娠的诊断价值[J].中国中西医结合影像学杂志,2016,14(2):215-217.
10 Wu X,Zhang XB,Zhu J,et al.Caesarean scar pregnancy:comparative efficacy and safety of treatment by uterine artery chemoembo-lization and systemic methotrexate injection[J].Eur J Obstet Gyne-col Reprod Biol,2012,161(1):75-79.
11 Birch Petersen K,Hoffmann E,Rifbijerg Larsen C,et al.Cesarean scar pregnancy:a systematic review of treatment studies[J].Fertil Steril,2016,105(4):958-967.
12 Bayoglu Tekin Y,Mate Ural U,Balk G,et al.Management of cesarean scar pregnancy with suction curettage a report of four cases and review of the literature[J].Arch Gynecol Obstet,2014,289(6):1171-1175.
13 Vetter MH,Andrzejewski J,Murnane A,et al.Surgical management of a heterotopic cesarean scar pregnancy with preservation of an intrauterine pregnancy[J].Obstet Gynecol,2016,128(3):613-616.
14 Litwicka K,Greco E.Caesarean scar pregnancy:a review of management options[J].Curr Opin Obstet Gynecol,2013,25(6):456-461.
15 黄卓敏,古衍,江曼茹.剖宫产瘢痕妊娠早期诊断与治疗方法的选择[J].中国计划生育学杂,2012,20(5):335-338.
16 Kim SM,Ahn HY,Choi MJ,et al.Uterine arteriovenous malformation with positive serum beta-human chorionic gonadotropin:Embolization of both uterine arteries and extra-uterine feeding arteries[J].Obstet Gynecol Sci,2016,59(6):554-558.
17 王素华.剖宫产切口瘢痕妊娠患者采用宫腔镜及子宫动脉栓塞术联合治疗的效果及安全性分析[J].中国内镜杂志,2016,22(9):84-87.
18 刘玮.宫腔镜手术治疗剖宫产术后子宫瘢痕妊娠的临床分析[J].中国医药导刊,2016,18(3):269-270.
19 Copelan A,Hartman J,Chehab M,et al.High-intensity focused ultrasound:current status for image-guid therapy[J].Semin Intervent Radiol,2015,32(4):398-415.
20 陈萍,王斌.药物预处理联合宫腔镜手术对剖宫产术后子宫瘢痕妊娠疗效的改善作用[J].2017,15(5):48-51.
21 杨江燕,袁郑文兰.加味宫外孕Ⅱ号方对早孕大鼠滋养细胞的影响[J].医学信息,2014,27(11):64-65.
22 何晓宁,邹淑波,王鸿艳.红花黄色素治疗宫外孕保守治疗后盆腔包块的效果分析[J].中国妇幼保健,2014,29(12):1881-1882.
2 蔡有芹,张昕蕾,张军.腹腔镜间断褥式内翻缝合法治疗Ⅱ型剖宫产瘢痕妊娠15例[J].中国微创外科杂志,2016,16(11):987-989.
3 Emmanouil K,Ioannis B,Konstantinos P,et al.Novel medical therapy of cesarean scar pregnancy with a viable embryo combining multidose methotrexate and mifepristone a case report[J].Medi-cine,2015,94(41):e1697.
4 谭明华,赵军,耿兮溪,等.不同术式联合治疗复杂剖宫产瘢痕妊娠的效果[J].中国医药,2016,11(5):724-728.
5 连成瑛,陈秀娟,林元,等.224例剖宫产术后子宫疤痕妊娠不同治疗方法的临床疗效分析[J].现代妇产科进展,2016,25(8):603-607.
6 Nautiyal D,Mukherjee K,Perhar I,et al.Comparative study of misoprostol in first and second trimester abortions by oral,sublingual,and vaginal routes[J].J Obstet Gynaecol India,2015,65(4):246-250.
7 魏玉梅,杨慧霞.巨大儿发生率和剖宫产率的变化趋势及其影响因素分析[J].中华妇产科杂志,2015,22(3):170-176.
8 周应芳,杨慧霞.重视剖宫产术后子宫瘢痕妊娠的预防和处置[J].中华妇产科杂志,2014,49(1):3-5.
9 王丽,郭翠荣,胡婠婧,等.经腹、经阴道彩色多普勒超声和腔内探头经腹超声对剖宫产瘢痕妊娠的诊断价值[J].中国中西医结合影像学杂志,2016,14(2):215-217.
10 Wu X,Zhang XB,Zhu J,et al.Caesarean scar pregnancy:comparative efficacy and safety of treatment by uterine artery chemoembo-lization and systemic methotrexate injection[J].Eur J Obstet Gyne-col Reprod Biol,2012,161(1):75-79.
11 Birch Petersen K,Hoffmann E,Rifbijerg Larsen C,et al.Cesarean scar pregnancy:a systematic review of treatment studies[J].Fertil Steril,2016,105(4):958-967.
12 Bayoglu Tekin Y,Mate Ural U,Balk G,et al.Management of cesarean scar pregnancy with suction curettage a report of four cases and review of the literature[J].Arch Gynecol Obstet,2014,289(6):1171-1175.
13 Vetter MH,Andrzejewski J,Murnane A,et al.Surgical management of a heterotopic cesarean scar pregnancy with preservation of an intrauterine pregnancy[J].Obstet Gynecol,2016,128(3):613-616.
14 Litwicka K,Greco E.Caesarean scar pregnancy:a review of management options[J].Curr Opin Obstet Gynecol,2013,25(6):456-461.
15 黄卓敏,古衍,江曼茹.剖宫产瘢痕妊娠早期诊断与治疗方法的选择[J].中国计划生育学杂,2012,20(5):335-338.
16 Kim SM,Ahn HY,Choi MJ,et al.Uterine arteriovenous malformation with positive serum beta-human chorionic gonadotropin:Embolization of both uterine arteries and extra-uterine feeding arteries[J].Obstet Gynecol Sci,2016,59(6):554-558.
17 王素华.剖宫产切口瘢痕妊娠患者采用宫腔镜及子宫动脉栓塞术联合治疗的效果及安全性分析[J].中国内镜杂志,2016,22(9):84-87.
18 刘玮.宫腔镜手术治疗剖宫产术后子宫瘢痕妊娠的临床分析[J].中国医药导刊,2016,18(3):269-270.
19 Copelan A,Hartman J,Chehab M,et al.High-intensity focused ultrasound:current status for image-guid therapy[J].Semin Intervent Radiol,2015,32(4):398-415.
20 陈萍,王斌.药物预处理联合宫腔镜手术对剖宫产术后子宫瘢痕妊娠疗效的改善作用[J].2017,15(5):48-51.
21 杨江燕,袁郑文兰.加味宫外孕Ⅱ号方对早孕大鼠滋养细胞的影响[J].医学信息,2014,27(11):64-65.
22 何晓宁,邹淑波,王鸿艳.红花黄色素治疗宫外孕保守治疗后盆腔包块的效果分析[J].中国妇幼保健,2014,29(12):1881-1882.