甲氨蝶呤联合超声引导下清宫术治疗子宫瘢痕妊娠的效果

胡丽华

摘 要 目的：探讨局部注射甲氨蝶呤联合经阴道超声引导下清宫术治疗子宫瘢痕妊娠的效果。方法：收集2016年7月至2018年4月收治的子宫瘢痕妊娠患者40例，按照治疗方案不同分为观察组20例和对照组20例。对照组采用深部肌肉注射甲氨蝶呤联合口服米非司酮治疗；观察组采用局部注射甲氨蝶呤联合经阴道超声引导下清宫术治疗。观察两组疗效、血HCG下降至正常时间、附件包块完全吸收时间。结果：观察组治愈率为90.00%（18/20），高于对照组的50.00%（10/20）（P<0.05）。观察组血HCG下降至正常时间和附件包块完全吸收时间分别为（16.34±3.69）d和（42.19±5.87）d，均低于对照组的（31.25±5.64）d和（48.33±8.04）d（P<0.05）。结论：局部注射甲氨蝶呤联合经阴道超声引导下清宫术治疗，能够提高子宫瘢痕妊娠的治疗效果，缩短血HCG下降至正常的时间、附件包块完全吸收的时间，应用价值较高。

关键词 子宫瘢痕妊娠；甲氨蝶呤；经阴道超声引导下清宫术

中图分类号：R714.46+1 文献标志码：A 文章编号：1006-1533（2019）16-0034-03

Effect of methotrexate combined with ultrasound-guided uterine curettage in the treatment of uterine scar pregnancy

HU Lihua（Obstetrics and Gynecology Department of Maternal and Child Health Care Hospital of Xinyu， Jiangxi Province 338025， China）

ABSTRACT Objective： To investigate the effect of local injection of methotrexate combined with transvaginal ultrasoundguided uterine curettage in the treatment of uterine scar pregnancy. Methods： Forty cases of uterine scar pregnancy from July 2016 to April 2018 were collected， and according to the treatment plan， they were divided into an observation group with 20 cases and a control group with 20 cases. The control group was treated with deep intramuscular injection of methotrexate combined with oral mifepristone， and the observation group was treated by local injection of methotrexate combined with transvaginal ultrasound-guided uterine curettage. The curative effect， the time of blood HCG descending to normal， and the complete absorption time of the accessory mass of the two groups were observed. Results： The cure rate of the observation group was 90.00%（18/20）， which was higher than that of the control group 50.00%（10/20）（P<0.05）. The time of blood HCG descending to normal， and the complete absorption time of the accessory mass in the observation group were （16.34±3.69） d and （42.19±5.87） d， respectively， which were lower than those in the control group （31.25±5.64） d and （48.33±8.04） d（P<0.05）. Conclusion： Local injection of methotrexate combined with transvaginal ultrasound-guided uterine curettage can improve the therapeutic effect of uterine scar pregnancy， shorten the time of blood HCG descending to normal， and the time of complete absorption of accessory mass， and the application value is higher.

KEY WORDS uterine scar pregnancy； methotrexate； transvaginal ultrasound-guided uterine curettage

剖宮产后瘢痕妊娠是临床常见剖宫产并发症[1]。随着剖宫产技术的成熟，剖宫产率不断上升，使剖宫产瘢痕妊娠的发生率不断增加[2]。子宫瘢痕妊娠会引起子宫破裂阴道大量出血等情况，对患者的生命安全造成严重威胁[3]，部分患者需要通过切除子宫来挽救生命。对于子宫瘢痕妊娠患者，采取积极的干预措施，减少危险情况的发生，具有重要意义。本文报道采用局部注射甲氨蝶呤联合经阴道超声引导下清宫术治疗子宫瘢痕妊娠的效果。