【摘要】 目的观察经阴道引导超声介导下局部注射甲氨蝶呤治疗子宫瘢痕妊娠的临床疗效及安全性。方法选取我院2017年1月～2018年12月收治的子宫瘢痕妊娠患者共60例,按照随机数字表法分为对照组与观察组。对照组患者接受甲氨蝶呤单次深部肌内注射治疗,观察组患者接受经阴道超声引导下甲氨蝶呤局部注射治疗。比较两组患者治疗后7d治愈率、清宫出血量、血HCG恢复正常时间、月经恢复正常时间及追加甲氨蝶呤次数、治疗前后血清妊娠相关蛋白(PAPP-A)、血管内皮生长因子(VEGF)、抑制素-A(INH-A)水平等指标。结果观察组子宫瘢痕妊娠治愈率显著高于对照组,差异有统计学意义(P <0.05)。观察组手术相关指标及术后恢复指标均显著优于对照组,差异有统计学意义(P <0.05)。两组治疗前血清PAPP-A、VEGF、INH-A水平无统计学差异(P> 0.05)。治疗后7d,观察组血清PAPP-A、VEGF、INH-A水平均显著低于对照组,差异有统计学意义(P <0.05)。观察组不良反应发生率显著低于对照组,差异有统计学意义(P <0.05)。结论经阴道超声引导下的甲氨蝶呤局部注射治疗子宫瘢痕妊娠效果优于单次深部肌内注射,能有效降低妊娠相关蛋白水平,能有效缩短月经、血HCG恢复正常时间,安全可靠。更多还原

【Abstract】 Objective To observe the clinical curative effects and safety of transvaginal ultrasound-mediated local injection of methotrexate in treatment of cesarean scar pregnancy. Methods 60 patients with cesarean scar pregnancy who were admitted and treated in our hospital from January 2017 to December 2018 were selected. They were divided into the control group and the observation group according to the random number table method. The control group was given a single deep intramuscular injection of methotrexate while the observation group was given transvaginal ultrasound-mediated local injection of methotrexate. The cure rate, blood loss in uterine curettage, blood HCG recovery time, menstrual recovery time and the number of additional methotrexate of 7 days after treatment and pregnancy associated plasma protein A(PAPP-A), vascular endothelial growth factor(VEGF) and inhibin-A(INH-A) levels before and after treatment were compared between the two groups. Results The cure rate of uterine scar pregnancy in the observation group was significantly higher than that in the control group, and the difference was statistically significant(P < 0.05). The operation related indexes and postoperative recovery indexes of the observation group were significantly better than those of the control group, and the difference was statistically significant(P < 0.05). There was no significant difference in serum levels of PAPP-A, VEGF and INH-A between the two groups before treatment(P > 0.05). On seven days after treatment, the serum levels of PAPP-A, VEGF and INH-A in the observation group were significantly lower than those in the control group, and the difference was statistically significant(P < 0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group, and the difference was statistically significant(P < 0.05). Conclusion The curative effect of transvaginal ultrasound-mediated local injection of methotrexate in treatment of cesarean scar pregnancy is better that of a single deep intramuscular injection. It can effectively reduce the level of pregnancy-related proteins and shorten the recovery time of menstruation and blood HCG. It is safe and reliable.更多还原