【摘要】 目的探讨甲氨喋呤(MTX)全身化疗后B超下清宫在切口妊娠治疗中的作用。方法 82例切口妊振患者分为两组:孕囊大部分突向宫腔组(A组,n=20)及孕囊主要侵入肌层组(B组,n=62),回顾性分析MTX肌肉或静脉注射后B超下清宫的成功率及其影响因素。结果 A组MTX静脉化疗4例B超下清宫均成功;肌肉注射MTX的16例中12例B超下清宫成功,4例因术中持续出血而行开腹手术。B组静脉化疗16例,14例B超下清宫成功,2例术后切口包块达浆膜而开腹;MTX肌肉化疗46例,42例B超下清宫成功,2例因术后切口处包块达浆膜层而开腹,另2例术中持续出血而开腹。MTX化疗后清宫手术成功率达87.80%。手术成功的72例与失败的10例治疗前血β-HCG水平之间差异有统计学意义(P<0.05)。结论 MTX全身化疗配合B超下清宫是治疗切口妊娠简单有效的方法,其成功率与治疗前血β-HCG水平的高低有关。更多还原

【Abstract】 Objective To evaluate the clinical efficacy of systemic metrotrexate(MTX)treatment and ultrasound-guided curettage in the treatment of cesarean scar pregnancy(CSP).Methods Eighty-two CSP patients who were treated with systemic MTX and then ultrasound-guided curettage were divided into 2groups:Group A(n=20),in which most gestational sac protruded to the uterine cavity,and group B(n=62),in which the gestaional sac progressed into the deep myometrial layer.The success rate of ultrasound-guided curettage after intramuscular(im)or intravenous(iv)MTX therapy and its influential factors were analyzed retrospectively.Results In group A,curettage was uneventful in 4patients who underwent preoperative iv MTX treatment and in 12 out of 16 patients who received preoperative im MTX treatment.Four patients who were given IM MTX treatment were complicated with heavy bleeding during curettage and followed by laparotomy.In group B,14 of 16patients who underwent preoperative iv MTX treatment had an uneventful curettage,and the other 2patients with the postoperative residual mass reaching the serosa were given laparotomy.Forty-two of 46 patients who underwent preoperative im MTX treatment had an uneventful curettage,and 2patients with heavy bleeding during curettage and 2patients with postoperative residual mass were followed by laparotomy.The success rate of ultrasound-guided curettage after systemic MTX therapy was 87.80%.Pretherapeutic levels of serumβ-HCG was statistically different between the uneventful 72 cases and the 10 cases in which laparotomy was given(P<0.05).Conclusion Ultrasound-guided curettage after systemic MTX therapy is a safe and effective treatment for CSP and pre-therapeutic levels of serumβ-HCG are correlated to the success rate of curettage.更多还原