超声引导下妊娠囊内注射甲氨蝶呤联合宫腔镜下清宫术治疗剖宫产瘢痕妊娠的临床应用分析

2022-06-06王文雁白殷孟萍萍

婚育与健康 2022年9期

王文雁白殷孟萍萍

【摘要】目的：讨论剖宫产瘢痕妊娠以超声引导下妊娠囊内注射甲氨蝶呤（Methotrexate，本文简称MTX）+宫腔镜下清宫术（Hysteroscopic Curettage，本文简称HC）治疗的效果。方法：选取2018年8月—2021年8月我院剖宫产瘢痕妊娠患者30例纳入研究，随机划成对照组与观察组两组，各15例。两组患者皆以注射MTX+HC治疗，但具体方式不同，对照组常规肌肉注射，观察组超声引导囊内注射，比较两组治疗效果。结果：观察组患者治疗总有效率高于对照组（P<0.05），β-HCG降低、月经恢复、住院等时间均短于对照组（P<0.05）。结论：超声引导下妊娠囊内注射MTX联合HC具有良好应用价值，对剖宫产瘢痕妊娠治疗的总有效率高，同时还有助于患者症状的快速恢复，值得肯定。

【关键词】超声引导；妊娠囊内注射；甲氨蝶呤；宫腔镜下清宫术；剖宫产瘢痕妊娠

Clinical application of ultrasound-guided intracapsular injection of methotrexate combined with hysteroscopic curettage in the treatment of cesarean scar pregnancy

WANG Wenyan， BAI Yin， MENG Pingping

Harbin 242 hospital， Harbin， Heilongjiang 150066， China

【Abstract】Objective：To evaluate the efficacy of ultrasound-guided intracapsular injection of methotrexate （MTX） andhysteroscopiccurettage （HC） in the treatment of cesarean scar pregnancy.Methods：From August 2018 to August 2021，28 cases of cesarean scar pregnancy in our hospital were enrolled in the study and randomly divided into control group and observation group，14 cases in each group. The two groups were treated by injecting MTX + HC， but the specific methods were different.The control group received routine intramuscular injection and the observation group received ultrasound-guided intracapsularinjection，the therapeutic effects of the two groups were compared. Results：The total effective rate of treatment in the observation group was higher than that in the control group（P<0.05）.The time of β-HCG reduction，menstrual recovery and hospitalization in the observation group was shorter than that in the control group（P<0.05）.Conclusion：Ultrasound-guided intracapsular injection of MTX combined with HC has a good application value.It has a high total effective rate in the treatment of cesarean scar pregnancy and is also contribute to the rapid recovery of patients with symptoms，it is worthy of affirmation.

【Key Words】Ultrasound guidance； Intrathecal injection of pregnancy； Methotrexate； Hysteroscopiccurettage； Cesarean scar pregnancy

瘢痕妊娠在臨床中的出现率较高，为剖宫产后常见的异位妊娠类型之一[1]。该瘢痕妊娠的形成，主要因剖宫产后宫颈管创口局部凹陷而妊娠囊存在于剖宫产缺陷位置所致。发生瘢痕的组织弹性往往不佳，因而还会引发诸多的合并疾病，如大出血、子宫破裂等，严重时甚至还危及患者生命安全[2]。目前，临床在治疗瘢痕妊娠时往往会选择药物治疗、子宫动脉栓塞治疗或手术治疗，不过，不同方案所实施的效果和安全性也不尽相同，均有着一定风险。而在当下，超声引导穿刺技术不断成熟，借助此方式可实现宫腔镜的有效操作，对清宫的效果也更佳[3]。鉴于此，本文将从超声引导方面着手，进行剖宫产瘢痕妊娠的治疗研究。现论述如下。