【摘要】 目的探讨子宫动脉阻断术对子宫瘢痕妊娠(CSP)患者孕酮及β-人绒毛膜促性腺激素(β-HCG)水平的影响。方法选取2014年4月至2015年4月荆州市中心医院收治的100例CSP患者,采用随机数字表法将患者分为甲氨蝶呤组和子宫动脉阻断术组,每组50例。甲氨蝶呤组肌内注射甲氨蝶呤,50 mg/m2,给药3 d后行腹腔镜下吸宫术;子宫动脉阻断术组给予子宫动脉阻断法治疗,阻断双侧子宫动脉后再行子宫瘢痕部位病灶清除术以及腹腔镜下吸宫术。比较两组患者的手术时间、术中出血量、住院时间,治疗前后血清孕酮及β-HCG水平,比较两组患者的不良反应发生率。结果甲氨蝶呤组与子宫动脉阻断术组患者手术时间比较,差异无统计学意义[(55.2±6.6)min比(58.4±5.1)min](P>0.05),子宫动脉阻断术组术中出血量少于甲氨蝶呤组,住院时间短于甲氨蝶呤组[(48.3±1.5)m L比(59.9±3.2)m L,(7.0±0.6)d比(8.0±0.4)d],差异有统计学意义(P<0.05)。治疗后,甲氨蝶呤组和子宫动脉阻断术组患者血清孕酮及β-HCG水平均较治疗前下降[(6.5±1.4)nmol/L比(28.0±6.1)nmol/L、(5.0±1.1)nmol/L比(27.9±5.9)nmol/L,(122.3±25.2)μg/L比(581.2±154.6)μg/L,(102.3±21.5)μg/L比(583.1±167.5)μg/L],差异有统计学意义(P<0.05),且子宫动脉阻断术组血清孕酮及β-HCG水平低于甲氨蝶呤组,差异有统计学意义(P<0.05)。甲氨蝶呤组术后总不良反应发生率为22.0%(11/50),子宫动脉阻断术组为14.0%(7/50),两组总不良反应发生率比较差异无统计学意义(P>0.05)。结论子宫动脉阻断术治疗CSP术中出血量少、住院时间短、血清中孕酮及β-HCG水平低,其效果优于甲氨蝶呤。更多还原

【Abstract】 Objective To investigate the influence of uterine arteries occlusion( UAO) on progesterone and β-human chorionic gonadotrophin( β-HCG) levels of patients with cesarean-scar pregnancy( CSP).Methods Total of 100 CSP cases were selected from Jingzhou Central Hospital between Apr. 2014 and Apr.2015,and were divided into a methotrexate( MTX) group and a UAO group by random number table method,50 cases in each group. The MTX group was given MTX 50 mg / m2,intramuscular injection,and received laparoscopic uterine aspirationafter 3 days of administration; the UAO group was given bilateral uterine arteries occlusion,then received laparoscopic focus clearance or uterine aspiration after UAO. The operation time,intraoperative blood loss,hospitalization days,progesterone and β-HCG levels before and after treatment and the incidence of adverse reactions between the two groups were compared. Results There was no statistically significant difference between the MTX group and UAO group on operation time [( 55. 2 ± 6. 6) min vs( 58. 4 ± 5. 1) min],intraoperative blood loss and hospitalization time of the UAO group were lower than the MTX group[( 48. 3 ± 1. 5) m L vs( 59. 9 ± 3. 2) m L,( 7. 0 ± 0. 6) d vs( 8. 0 ± 0. 4) d,P < 0. 05]. The levels of serum progesterone and β-HCG of the two groups were significantly lower than before treatment[( 6. 5 ± 1. 4) nmol/L vs( 28. 0 ± 6. 1) nmol/L,( 5. 0 ± 1. 1) nmol/L vs( 27. 9 ± 5. 9) nmol/L,( 122. 3 ±25. 2) μg / L vs( 581. 2 ± 154. 6) μg / L,( 102. 3 ± 21. 5) μg / L vs( 583. 1 ± 167. 5) μg / L) nmol / L],and the UAO group was lower than the MTX group( P < 0. 05). The incidence of postoperative adverse reactions of MTX group and UAO group statistically significant difference [22. 0%( 11 /50) vs 14. 0%( 7 /50) ]( P >0. 05). Conclusion UAO treating in CSP is better than MTX,featured with less blood loss,shorter hospital stay,lower serum progesterone in β-HCG levels.更多还原