米非司酮、局部注射甲氨蝶呤聯(lián)合可視人流吸宮及Foley導(dǎo)尿管壓迫止血保守治療剖宮產(chǎn)瘢痕妊娠的臨床研究

黃碧瑗+吳蘭+李婷

【摘要】 目的 探究米非司酮、局部注射甲氨蝶呤聯(lián)合可視人工流產(chǎn)（人流）吸宮及Foley導(dǎo)尿管壓迫止血保守治療剖宮產(chǎn)瘢痕妊娠（CSP）的臨床效果。方法 46例剖宮產(chǎn)瘢痕妊娠患者， 根據(jù)治療方案的不同分為治療組和對(duì)照組， 各23例。對(duì)照組患者予以米非司酮口服、甲氨蝶呤肌內(nèi)注射， 之后在可視人流機(jī)下行吸宮術(shù)；治療組予以米非司酮片口服， 同時(shí)在B超介導(dǎo)下行孕囊內(nèi)注射甲氨蝶呤， 吸宮術(shù)后常規(guī)用Foley導(dǎo)尿管球囊置宮腔局部壓迫。比較在用藥8 h后兩組患者孕囊活性和用藥后4 d、1周及2周時(shí)患者血清人絨毛膜促性腺激素（β-HCG）值及血β-HCG轉(zhuǎn)陰時(shí)間， 并對(duì)此患者術(shù)中、術(shù)后24 h陰道出血量及平均住院時(shí)間。結(jié)果 治療組患者用藥后4 d、1周、2周的血β-HCG值及β-HCG轉(zhuǎn)陰時(shí)間均明顯少于對(duì)照組， 差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療組患者用藥后孕囊活性降低率為52.2%及治療成功率為100.0%， 均高于對(duì)照組的17.4%和82.6%， 差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療組患者的術(shù)中、術(shù)后24 h陰道出血量及住院時(shí)間均明顯少于對(duì)照組， 差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 米非司酮、局部注射甲氨蝶呤聯(lián)合可視人流吸宮及Foley導(dǎo)尿管壓迫止血保守治療剖宮產(chǎn)瘢痕妊娠臨床效果顯著， 既能縮短保守治療時(shí)間， 又能降低清宮時(shí)出血風(fēng)險(xiǎn)， 值得臨床推廣。

【關(guān)鍵詞】 剖宮產(chǎn)瘢痕妊娠；米非司酮；甲氨蝶呤；吸宮；Foley導(dǎo)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.