子宫动脉栓塞 MTX 介入及清宫术联合用于疤痕妊娠的疗效及可行性

摘要

Objective To explore the feasibility and effect of uterine artery embolization and curettage combined with methotrexate (MTX)intervention for treatment of patients with scar pregnancy. Methods Ninety six patients with cesarean scar pregnancy during January 2010 to December 2013 were divided into trial group( uterine arterial embolism plus MTX intervention)and control group( local injection of MTX),each group with 48 cases,and patients in these two groups were given with curettage. The prognosis and satisfactory rate of patients were compared between these two groups with two therapeutic methods. Results The time for menopause,the diameter of pregnancy sac and the rever-sion rate of β - HCG in trial group were compared with those of control group,there was no significant difference( P ﹥ 0. 05). The curettage bleeding,medical expenses and β - HCG clearance time in patients of trial group compared with those of patients in control group,the difference was statistically significant( P ﹤ 0. 01). In comparison with control group,the recovery time of HCG,the duration for disappearance of scar mass in ultrasound and menstrual recovery time in trial group were significantly decreased,and the difference was statistically significant( P ﹤ 0. 01). The recovery of regular menstruation and normal pregnancy had been compared between these two groups,and the difference was not statistically significant( P ﹥ 0. 05). Conclusion The application of combined therapy of uterine artery embolization,MTX intervention and curettage in treatment of scar pregnancy can significantly reduce the amount of bleeding during operation and the occurrence of postoperative complications. It is worthy to be applied for clinical popularization.%目的：探讨分析子宫动脉栓塞甲氨喋呤（MTX）介入及清宫术联合用于疤痕妊娠的疗效及可行性。方法选取2010年1月到2013年12月的剖宫产术后子宫疤痕妊娠患者96例，分为实验组（子宫动脉栓塞 MTX 介入加清宫术）和对照组（MTX 局部注射加清宫术），各48例。比较两组患者治疗情况和预后情况。结果观察组停经时间、孕囊直径以及β绒毛膜促性腺激素（β- HCG）与对照组相比，差异无统计学意义（ P ﹥0.05）；观察组患者清宫术出血量和β- HCG 转阴时间低于对照组，但医疗费用高于对照组，差异有统计学意义（ P ﹤0.01）；观察组 HCG 恢复正常时间、超声瘢痕处包块消失时间、月经恢复时间与对照组相比，明显降低，差异有统计学意义（ P ﹤0.01）；两组患者月经规律、再次正常妊娠情况相比，差异无统计学意义（ P ﹥0.05）。结论子宫动脉栓塞 MTX 介入及清宫术联合用于疤痕妊娠的疗效确切，可以明显减少术中出血量和术中、术后并发症，值得在临床上推广。