甲氨喋呤联合宫腔镜治疗剖宫产疤痕部位妊娠43例分析

目的 探讨甲氨喋呤联合宫腔镜治疗剖宫产疤痕部位妊娠（CSP）的可行性及疗效.方法 选取CSP患者43例,随机分成3组.研究组（18例）是在B超引导下经阴道妊娠囊局部穿刺注射MTX 50 mg,血β-HCG下降至100 mIU/ml以下后行宫腔镜电切清除病灶;对照组一（12例）是在B超引导下经阴道妊娠囊局部注入MTX 50 mg,血β-HCG下降至l00mIU/ml以下后在B超监测下行清宫术;对照组二（13例）是予MTX 50mg臀部肌注,每日1次,共2次,血β-HCG下降至100 mIU/ml以下后在B超监测下行清宫术;观察术中失血量、平均住院时间、血β-HCG消退时间、医疗费用.结果 研究组术中失血量、平均住院时间、血β-HCG消退时间、医疗费用分别为（60±10）ml、（7±1）天、（14±2）天、（1500±100）元;对照组一术中失血量、平均住院时间、血β-HCG消退时间、医疗费用分别为（200±20）ml、（8±1）天、（16±2）天、（2000±200）元;对照组二术中失血量、平均住院时间、血β-HCG消退时间、医疗费用分别为（250±20）ml、（14±2）天、（28±2）天、（2500±200）元;研究组与两个对照组比较差异均有显著性（P＜0.05）.结论 甲氨喋呤联合宫腔镜治疗CSP具有安全有效、住院时间短、医疗费用低等优点.

The clinical efficacy of combined lacalmethotrexate with Hysteroscopy in the treatment of Cesarean Scar

Objective To investigate the feasibility and clinical efficacy of the combination of lacalmethotrexate with Hysteroscopy in the treatmertt of CSP. Methods 43 patients diagnosed with CSP were divided into three groups: the study group(n=18) received an intra - amniotic methotrexate injection or methotrexate injection into the ectopic gestational mass and surrounding myometrium under ultrasound - guide. When the level of HCG in serum gradually dropped to less than 100 mIU/ml, the patients underwent operative hysteroscopy to remove the ectopic geasational tissue. the NO.1 control group(n=12)were uterined curettage under ultrasound - guided aftet same lacalmethotrexate, the NO.2 control group (n=13) were uterined curettage under ultrasound - guided aftet methotrexate injection. Results All the cases in study group were preformed success more fully to avoid hysterectomy than control group and preserve the reproductive capacity. Blood loss was more limited, the patients were recovered more quicklly,and the prognosis was satisfactory(P＜ 0.05). Conclusion Methotrexate combined with hysteroscopy to cure CSP has the advantages of safety, efficacy, short hospital stay, and low cost.