米非司酮、局部注射甲氨蝶呤联合可视人流吸宫及Foley导尿管压迫止血保守治疗剖宫产瘢痕妊娠的临床研究

黄碧瑗+吴兰+李婷

【摘要】 目的 探究米非司酮、局部注射甲氨蝶呤聯合可视人工流产（人流）吸宫及Foley导尿管压迫止血保守治疗剖宫产瘢痕妊娠（CSP）的临床效果。方法 46例剖宫产瘢痕妊娠患者， 根据治疗方案的不同分为治疗组和对照组， 各23例。对照组患者予以米非司酮口服、甲氨蝶呤肌内注射， 之后在可视人流机下行吸宫术；治疗组予以米非司酮片口服， 同时在B超介导下行孕囊内注射甲氨蝶呤， 吸宫术后常规用Foley导尿管球囊置宫腔局部压迫。比较在用药8 h后两组患者孕囊活性和用药后4 d、1周及2周时患者血清人绒毛膜促性腺激素（β-HCG）值及血β-HCG转阴时间， 并对此患者术中、术后24 h阴道出血量及平均住院时间。结果 治疗组患者用药后4 d、1周、2周的血β-HCG值及β-HCG转阴时间均明显少于对照组， 差异均有统计学意义（P<0.05）。治疗组患者用药后孕囊活性降低率为52.2%及治疗成功率为100.0%， 均高于对照组的17.4%和82.6%， 差异均有统计学意义（P<0.05）。治疗组患者的术中、术后24 h阴道出血量及住院时间均明显少于对照组， 差异均有统计学意义（P<0.05）。结论 米非司酮、局部注射甲氨蝶呤联合可视人流吸宫及Foley导尿管压迫止血保守治疗剖宫产瘢痕妊娠临床效果显著， 既能缩短保守治疗时间， 又能降低清宫时出血风险， 值得临床推广。

【关键词】 剖宫产瘢痕妊娠；米非司酮；甲氨蝶呤；吸宫；Foley导尿管

DOI：10.14163/j.cnki.11-5547/r.2017.08.009

【Abstract】 Objective To explore the clinical effect of mifepristone， methotrexate local injection combined with visible abortion uterine aspiration and Foley catheter compressing hemostasis in conservative treatment of cesarean scar pregnancy （CSP）. Methods A total of 46 cesarean scar pregnancy patients were divided by treatment regimens into treatment group and control group， with 23 cases in each group. The control group received oral mifepristone， intramuscular injection of methotrexate and then uterine aspiration by visual abortion machine， and the treatment group received oral mifepristone， fertilized egg injection of methotrexate guided by B-mode ultrasonography， and Foley catheter compressing hemostasis after uterine aspiration. Comparison were made on fertilized egg activity after 8 h of meditation， serum β subunit of human chorionic gonadotropin （β-HCG） value and blood β-HCG negative conversion time after 4 d， 1 and 2 week of meditation， intraoperative and postoperative vaginal bleeding volume in 24 h and average hospital stay time in two groups. Results The treatment group had less blood β-HCG value and β-HCG negative conversion time after 4 d， 1 and 2 week of meditation than the control group， and their difference had statistical significance （P<0.05）. The treatment group had fertilized egg activity reducing rate as 52.2%， treatment success rate as 100.0%， which were all higher than 17.4% and 82.6% in the control group， and their difference had statistical significance （P<0.05）. The treatment group had less intraoperative and postoperative vaginal bleeding volume in 24 h and hospital stay time than the control group， and their difference had statistical significance （P<0.05）. Conclusion Combination of mifepristone， methotrexate local injection and visible abortion uterine aspiration， Foley catheter compressing hemostasis shows significant clinical effect in conservative treatment of cesarean scar pregnancy， and it can not only shorten conservative treatment time， but also reduce bleeding risk in complete curettage of uterine cavity. So it is worth clinical promotion.