甲氨蝶呤联合UACE在CSP患者妊娠物清除中应用研究

doi:10.3969/j.issn.1006-6233.2023.05.018

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摘要 目的:探讨甲氨蝶呤联合子宫动脉化疗栓塞术(UACE)在子宫瘢痕妊娠(CSP)患者妊娠物清除中应用效果。方法:选取2020年5月至2021年12月来我院就诊的CSP患者84例,按照随机数字表法分为观察组和对照组,各42例。对照组患者给予甲氨蝶呤治疗,观察组患者给予甲氨蝶呤联合UACE治疗,比较临床疗效、手术一般情况、妊娠物消失时间和血β-HCG恢复正常时间、卵巢功能指标[卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(PROG)]、并发症发生情况。结果:观察组与对照组总有效率分别为97.62%、83.33%,观察组比对照组高(P<0.05)。观察组术中出血量显著少于对照组,住院时间明显比对照组短(P<0.05),而两组手术时间比较差异不明显(P>0.05)。观察组妊娠物消失时间和血β-HCG恢复正常时间显著早于对照组(P<0.05)。术后3、6个月两组不同治疗方式对患者卵巢功能指标影响无显著差异(P>0.05)。观察组与对照组并发症发生率分别为7.14%、11.90%,差异无统计学意义(P>0.05)。结论:甲氨蝶呤联合UACE对CSP患者疗效较好,可有效改善患者症状,减少术中出血量和缩短住院时间,同时有效清除妊娠物,且对卵巢功能影响较小,并发症少。

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	施平
	耿姣姣
	许峰

关键词 ：甲氨蝶呤, 子宫动脉化疗栓塞术, 子宫瘢痕妊娠, 妊娠物清除

Abstract：Objective: To investigate the application effect of methotrexate combined with uterine arterial chemoembolization (UACE) in the removal of pregnancy substances in patients with cesarean scar pregnancy (CSP). Methods: A total of 84 CSP patients admitted to our hospital from May 2020 to December 2021 were selected and divided into an observation group and a control group according to the random number table method, with 42 cases in each. The control group was given methotrexate, and the observation group was given methotrexate combined with UACE. The data were compared including clinical efficacy, general operation, disappearance time of pregnancy substance, time to return to normal blood β-HCG, ovarian function indexes [follicle-stimulating hormone]. (FSH), luteinizing hormone (LH), estradiol (E2), progesterone (PROG)], and occurrence of complications. Results: The total effective rates of the observation group and the control group were 97.62% and 83.33%, respectively. The observation group had higher effective rate than the control group (P<0.05). The intraoperative blood loss in the observation group was significantly less than that in the control group, and the hospital stay was significantly shorter than that in the control group (P<0.05), while there was no significant difference in operation time between the two groups (P>0.05). The time to disappearance of pregnancy material and the time to normalization of blood β-HCG in the observation group were significantly earlier than those in the control group (P<0.05). There was no significant difference in the effect of different treatment methods on ovarian function indexes between the two groups at 3 and 6 months after operation (P>0.05). The incidence of complications in the observation group and the control group were 7.14% and 11.90%, respectively, and the difference was not statistically significant (P>0.05). Conclusion: Methotrexate combined with UACE has good curative effect on CSP patients, can effectively improve the symptoms of patients, reduce intraoperative blood loss and shorten the hospitalization time, and at the same time effectively remove pregnancy substance, and has less impact on ovarian function and fewer complications.

Key words： Methotrexate Uterine arterial chemoembolization Cesarean scar pregnancy Removal of pregnancy material

基金资助:湖北省卫生和计划生育委员会,(编号:2017CFB688)

通讯作者: 耿姣姣

引用本文:

施平, 耿姣姣, 许峰. 甲氨蝶呤联合UACE在CSP患者妊娠物清除中应用研究[J]. 河北医学, 2023, 29(5): 790-794.
SHI Ping, GENG JiaoJiao, et al. Application of Methotrexate Combined with UACE in the Removal of Pregnancy Substances in CSP Patients. HeBei Med, 2023, 29(5): 790-794.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.05.018 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I5/790

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