B超引导孕囊内注射MTX治疗剖宫产后瘢痕妊娠44例临床分析

摘要

目的：观察B超引导孕囊内注射甲氨蝶呤（MTX）治疗剖宫产后瘢痕妊娠（CSP）的临床疗效。方法：将剖宫产后瘢痕妊娠患者90例按随机数字表法分为研究组与对照组。研究组给予B超引导孕囊内注射MTX，对照组给予MTX肌肉注射。观察两组患者的临床治愈率、住院时间；治疗前后血孕酮、β-人绒毛膜促性腺激素（β-hCG）、妊娠包块直径的变化；治疗期间患者出现的不良反应。结果：研究组临床治愈率为95.45%，对照组为52.17%，差异有统计学意义（P<0.05）；研究组平均住院时间为（7.1±2.0）d，β-hCG恢复正常时间为（26.6±5.6）d，对照组分别为（15.4±3.6）d、（35.5±3.6）d，差异均有统计学意义（P<0.05）；研究组患者治疗后血孕酮、β-hCG、妊娠包块直径分别为（4.0±2.1）ng/mL、（315.6±60.6）U/L、（0.5±0.3）cm，对照组分别为（7.9±3.6）ng/mL、（786.3±88.3）U/L、（1.7±0.6）cm，差异均有统计学意义（P<0.05）；研究组谷丙转氨酶（ALT）升高、恶心呕吐、血白细胞（WBC）升高发生率分别为25.00%、9.09%、2.27%，对照组分别为54.35%、26.09%、15.22%，差异均有统计学意义（P<0.05）。结论：B超引导孕囊内注射MTX治疗剖宫产后瘢痕妊娠的疗效确切，能够快速起效，且临床不良反应较少，值得推广。%Objective:To observe the clinical curative effect of B ultrasound guided injection of methotrexate in gestational sac(MTX) with MTX in pregnancy intramuscular injection in treatment of cesarean scar(CSP). Method:90 cases of pregnancy patients with cesarean scar were selected in our hospital,according to radom digit table, they were divided into the study group and control group.The study group was given therapeutic by ultrasound guided injection in gestational sac MTX, the control group was given intramuscular MTX injection. The clinical cure rate, hospitalization time, blood progesterone; beta human chorionic gonadotropin (Human Chorionic Gonadotropin, beta-hCG), the changes of pregnancy mass diameter of two groups patients were observed before and after treatment. In addition, adverse reactions of hospitalized patients were observed during the treatment.Result: Clinical cure rate of the study group was 95.45%, the clinical cure rate of control group was 52.17%, the difference was significant(P<0.05).The average hospitalization time of the study group was (7.1±2.0)d,beta-hCG to restore the normal time was (26.6±5.6)d,the average hospitalization time of the control group was (15.4±3.6)d,beta-hCG to restore the normal time was (35.5±3.6)d, there was significant difference (P<0.05).Beta-hCG, pregnancy mass diameter of the study group patients after the blood progesterone were (4.0±2.1)ng/mL,(315.6±60.6)U/L,(0.5±0.3)cm,the control group were respectively (7.9±3.6)ng/mL,(786.3±88.3)U/L,(1.7±0.6)cm,difference were significant (P<0.05).Alanine aminotransferase(ALT),nausea and vomiting,elevated white blood cell (WBC) increased rates of the study group were 25.00%,9.09% and 2.27%, the control group were 54.35%,26.09% and 15.22%,there were significant difference (P<0.05).Conclusion:B ultrasound guide therapeutic effect of gestational sac injection in the treatment of cesarean scar pregnancy MTX exactly, can rapid onset and had clinical and less adverse reactions,it is worthy of promotion.