摘要
目的 探讨甲氨蝶呤切口及不同给药方法联合宫腔镜手术治疗剖宫产瘢痕妊娠(cesarean scarpregnancy,CSP)的可行性.方法 回顾性分析2001年1月~2015年12月嘉兴市妇幼保健院收治的106例CSP患者的临床资料,将其分为2组,其中A组66例:甲氨蝶呤(MTX)切口及全身给药方法联合宫腔镜手术治疗.B组40例:甲氨蝶呤全身给药方法联合宫腔镜手术治疗.比较2组的手术时间、术中出血量、术前住院时间、血HCG下降至正常的时间、总的MTX用量及肝功能异常率等,并分析影响CSP预后的因素.结果 2组术前住院时间,肝功能异常比较,差异有统计学意义(P<0.05);A组治疗成功者与失败者的治疗前血HCG、孕囊与膀胱壁之间子宫肌层的厚度(MT),差异均有统计学意义(P<0.05).治疗成功患者的孕囊直径(GS)中位数为17.1 mm,失败者的中位数为6.2 mm,GS在两者间比较,差异有统计学意义(P<0.05).结论 甲氨蝶呤切口及全身给药方法联合宫腔镜手术治疗相对于单纯全身给药联合宫腔镜手术是一种更安全有效且住院时间短的方法,但MT>3 mm、治疗前血HCG≤20000 IU/L、GS≤40 mm的CSP更安全.
Abstract
Objective To investigate the feasibility of methotrexate incision and different methods of administration combined with hysteroscopic surgery for cesarean scarpregnancy (CSP).Methods Retrospective analysis of 106 patients with CSP in our hospital from January 2001 to December 2015 were.The patients were divided into two groups, group A of 66 cases: methotrexate ( MTX) incision and systemic administration combined with hysteroscopic surgery group B of 40 cases: methotrexate combined with hysteroscopy surgery.The operation time, intraoperative blood loss, preoperative hospital stay, the time of blood HCG decreased to normal, the total amount of MTX and the abnormal rate of liver function were compared between the two groups, and the factors affecting the prognosis of CSP were analyzed.Results The preoperative hospitalization time and abnormal liver function of the two groups were compared, the difference was statistically significant(P<0.05).A group of patients with success and failure, blood HCG before treatment, gestational sac and bladder wall thickness of the myometrium (MT), the difference was statistically significant (P<0.05).The median gestational sac diameter ( GS) of patients with successful treatment was 17.1 mm, and the median number of patients was 6.2 mm, and the difference was statistically significant between the two groups ( GS ) , the difference of GS between the two groups was statistically significant ( P<0.05 ) . Conclusion Methotrexate incision and systemic administration methods combined with hysteroscopy treatment compared with systemic administration combined with hysteroscopy is a safe and effective method and the hospitalization time is short, but the MT >3 mm, before treatment, blood HCG≤20000IU/L, GS≤40 mm CSP more secure.
NETL
NSTL
维普
万方数据