超声引导下胚囊注射甲氨蝶呤治疗CSP疗效分析

摘要

目的 探讨超声引导下甲氨蝶呤(MTX)胚囊注射治疗剖宫产瘢痕妊娠(CSP)的疗效.方法 选择2010年1月至2015年12月期间潍坊市妇幼保健院妇产科诊治的41例剖宫产瘢痕妊娠,按治疗方法分为两组:研究组21例,超声引导下行MTX胎囊局部注射;对照组20例,行子宫动脉化疗栓塞.复查血人绒毛膜促性腺激素(hCG),若1周血hCG下降<15%,则给予单次肌注MTX,可重复给予.比较两组的治愈率、血hCG降至正常的时间及MTX用量.结果 两组治疗成功率(χ2=0.212,P=0.645)、血hCG降至正常的时间(t=0.763,P=0.801)及MTX用量(χ2=0.200,P=0.655)差异无统计学意义.保守失败组中妊娠囊>3cm的为66.67%(6/9),明显高于治愈组的9.38%(3/32),差异有统计学意义(χ2=10.321,P=0.001);保守失败组中Ⅱ型瘢痕妊娠为70.00%(7/10),明显高于治愈组的9.38%(3/32),差异有统计学意义(χ2=14.306,P=0.000).结论 超声引导下甲氨蝶呤胚囊注射治疗剖宫产瘢痕妊娠疗效确切,方法简单,对设备的要求低,在基层医院病情允许者可作为其治疗首选.%Objective To explore the treatment effect of ultrasound-guided methotrexate ( MTX) injection in embryo sac on cesarean scar pregnancy (CSP).Methods Forty-one patients with CSP treated in obstetrics and gynecology department in Weifang Maternal and Child Health Care Hospital from January 2010 to December 2015 were selected and divided into two groups according to different treatment methods, including 21 cases in study group treated with ultrasound-guided MTX injection in gestational sac and 20 cases in control group treated with uterine artery chemoembolization .Serum human chorionic gonadotropin ( HCG) was rechecked , and single dose intramuscular MTX injection was given if serum HGC dropped less than 15%after one week, and then MTX injection could be repeated .Cure rate, time for serum HCG dropping to normal level and amount of MTX administrated were compared between two groups .Results There was no significant difference in cure rate (χ2 =0.212, P=0.645), time for serum HCG dropping to normal level (t=0.763, P=0.801) and amount of administrated MTX (χ2 =0.200, P =0.655 ) between two groups .Patients with gestational sac bigger than 3cm occupied 66.67%(6/9) in failed cases, which was significantly higher than that ( 9.38%, 3/32 ) in successful cases and difference was statistically significant (χ2 =10.321, P=0.001).Patients with type II CSP accounted for 70.00% (7/10) in failed cases, which was significantly higher than that (9.38%, 3/32) in successful cases and difference had statistical significance (χ2 =14.306, P=0.000). Conclusion Treatment effect of ultrasound-guided methotrexate ( MTX) injection in embryo sac on CSP is assuring .Its operation is easy and its requirement on equpiment is low .It can be used as preferred method for treating patients with suitable conditions in primary hospital.