[1]李艳川,邓小艳,樊阳阳,等.甲氨蝶呤灌注联合子宫动脉栓塞和超声引导下刮宫术治疗子宫瘢痕妊娠的疗效及安全性[J].新乡医学院学报,2019,36(3):246-249.[doi:10.7683/xxyxyxb.2019.03.010]
　LI Yan-chuan,DENG Xiao-yan,FAN Yang-yang,et al.Effect and safety of methotrexate perfusion combined with uterine artery embolization and ultrasound-guided uterine curettage in the treatment of cesarean scar pregnancy[J].Journal of Xinxiang Medical University,2019,36(3):246-249.[doi:10.7683/xxyxyxb.2019.03.010]
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甲氨蝶呤灌注联合子宫动脉栓塞和超声引导下刮宫术治疗子宫瘢痕妊娠的疗效及安全性
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
36
期数:
2019年3
页码:
246-249
栏目:
临床研究
出版日期:
2019-03-05

文章信息/Info

Title:
Effect and safety of methotrexate perfusion combined with uterine artery embolization and ultrasound-guided uterine curettage in the treatment of cesarean scar pregnancy
作者:
李艳川1; 邓小艳1; 樊阳阳1; 屈秋慧2
（1.陕西省人民医院产科，陕西　西安　710068；2.西安医学院第二附属医院产科，陕西　西安　710038）
Author(s):
LI Yan-chuan1; DENG Xiao-yan1; FAN Yang-yang1; QU Qiu-hui2
（1.Department of Obstetrics，Shaanxi Provincial People′s Hospital，Xi′an 710068，Shaanxi Province，China；2.Department of Obstetrics，the Second Affiliated Hospital of Xi′an Medical University，Xi′an 710038，Shaanxi Province，China）
关键词:
子宫瘢痕妊娠; 超声引导; 刮宫术; 子宫动脉栓塞; 甲氨蝶呤
Keywords:
cesarean scar pregnancy; ultrasonic guidance; uterine curettage; uterine artery embolization; methotrexate
分类号:
R714.22
DOI:
10.7683/xxyxyxb.2019.03.010
文献标志码:
A
摘要:
目的　探讨甲氨蝶呤灌注联合子宫动脉栓塞和超声引导下刮宫术治疗子宫瘢痕妊娠（CSP）的临床效果及安全性。方法　选择2015年2月至2017年10月陕西省人民医院收治的106例CSP患者为研究对象，根据患者意愿及治疗方法将患者分为观察组（n=52）和对照组（n=54），观察组患者给予甲氨蝶呤灌注联合双侧子宫动脉栓塞和超声引导下刮宫术，对照组患者给予妊娠囊内注射甲氨蝶呤联合超声引导下刮宫术。记录2组患者的手术时间、术中出血量、住院时间、月经恢复时间、人绒毛膜促性腺激素（HCG）水平恢复时间、病灶消失时间及术后并发症；术后2个月，根据患者临床症状改善情况和血清HCG恢复情况评价临床疗效；术后6个月，应用生存质量测定量表评价2组患者的生活质量。结果　观察组和对照组患者治疗有效率分别为98.01%（51/52）、94.44%（51/54），2组患者治疗有效率比较差异无统计学意义（χ2=1.034，P>0.05）。观察组患者手术时间和住院时间短于对照组（P<0.05），但2组患者术中出血量比较差异无统计学意义（P>0.05）。观察组患者月经恢复时间、HCG恢复时间及病灶消失时间显著短于对照组（P<0.05）。术后3个月，观察组患者生理领域和社会关系领域评分高于对照组（P<0.05），但2组患者心理领域和环境领域评分比较差异无统计学意义（P>0.05）；2组患者术后6个月生活质量评分比较差异无统计学意义（P>0.05）。观察组和对照组患者术后并发症发生率分别为3.85%（3/52）、18.52%（10/54），观察组患者术后并发症发生率低于对照组（χ2=7.791，P<0.05）。结论　甲氨蝶呤灌注联合子宫动脉栓塞和超声引导下刮宫术与妊娠囊内注射甲氨蝶呤联合超声引导下刮宫术治疗CSP的临床疗效相当，但甲氨蝶呤灌注联合子宫动脉栓塞和超声引导下刮宫术治疗CSP具有手术时间短、患者术后恢复快、术后并发症发生率低等优势，且能在短期内有效改善患者的生活质量。
Abstract:
Objective　To investigate the clinical effect and safety of methotrexate perfusion combined with uterine artery embolization and ultrasound-guided uterine curettage in the treatment of cesarean scar pregnancy （CSP）.Methods　A total of 106 patients with CSP in Shaanxi Provincial People′s Hospital from February 2015 to October 2017 were selected as the research subjects，and the patients were divided into observation group （n=52） and control group （n=54） according to the patients′ wishes and treatment methods.The patients in the observation group were treated with methotrexate perfusion combined with bilateral uterine artery embolization and ultrasound-guided uterine curettage，while the patients in the control group were treated with intracapsular injection of methotrexate combined with ultrasound-guided uterine curettage.The operation time，intraoperative bleeding volume，hospitalization time，menstrual recovery time，recovery time of human chorionic gonadotropin （HCG） level，focal disappearance time and postoperative complications of the patients in the two groups were recorded.The clinical effect was evaluated according to the improvement of clinical symptoms and the recovery of serum HCG at two months after operation.The quality of life of the patients in the two groups was evaluated by the quality of life scale at six months after operation.Results　The effective rate in the observation group and the control group was 98.01% （51/52） and 94.44% （51/54），respectively.There was no significant difference in the effective rate between the two groups （χ2=1.034，P>0.05）.The operation time and hospitalization time in the observation group were shorter than those in the control group （P<0.05），but there was no significant difference in intraoperative bleeding volume between the two groups （P>0.05）.The menstrual recovery time，HCG recovery time and focal disappearance time in the observation group were significantly shorter than those in the control group （P<0.05）.At three months after operation，the scores of physiological and social relationship fields in the observation group were higher than those in the control group （P<0.05），but there was no significant difference in the scores of psychological and environmental fields between the two groups （P>0.05）.There was no significant difference in quality of life score between the two groups at six months after operation （P>0.05）.The incidence of postoperative complications in the observation group and the control group was 3.85% （3/52） and 18.52% （10/54），respectively.The incidence of postoperative complications in the observation group was lower than that in the control group （χ2=7.791，P<0.05）.Conclusion　Methotrexate perfusion combined with uterine artery embolization and ultrasound-guided uterine curettage has the same clinical effect as intracapsular injection of methotrexate combined with ultrasound-guided uterine curettage in the treatment of CSP.However，methotrexate perfusion combined with uterine artery embolization and ultrasound-guided uterine curettage for CSP has the advantages of short operation time，fast recovery，low incidence of postoperative complications，and can effectively improve the quality of life of patients in short term.

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更新日期/Last Update: 2019-03-05