摘要
目的探讨术前应用氨甲蝶呤(MTX)预防子宫瘢痕妊娠(CSP)清宫术大出血的价值及适宜的给药方法。方法回顾性分析接受MTX联合清宫术治疗的10例CSP患者的临床资料,评价2种局部给药方法降低血β-人绒毛膜促性腺激素(β-HCG)的效果。结果 10例均为孕囊内生型,其中5例伴轻微外凸,子宫前壁下段肌层厚度0.1~0.4cm,初始血β-HCG水平16 509~179 673U/L。每例患者接受2次宫颈和/或超声引导下孕囊内注射MTX,总用药量100~150mg。清宫术前血β-HCG降至1 724~43 486U/L。4例发生大出血,其中2例保守治疗成功、1例接受经腹病灶切除及瘢痕修补术、1例接受子宫动脉栓塞术。宫颈内注射MTX共6例次,除1例次孕囊内追加注射无水乙醇外,其余5例次均无效;孕囊内注射14例次全部有效,血β-HCG下降率达27.78%～89.00%,中位下降率65.96%。结论在MTX联合清宫术治疗CSP中,孕囊内注射给药降低血β-HCG效果明显优于宫颈内注射给药,宜首选超声引导下孕囊内注射给药。
Objective To explore the value of using methotrexate(MTX)preoperatively to prevent massive hemorrhage during uterine curettage and the appropriate local administration method of MTX in treatment of cesarean scar pregnancy(CSP).Methods Clinical data and the efficacy of two local administration procedures in decreasing serumβ-human chorionic gonadotrophin(β-HCG)level in 10 patients with CSP were retrospectively analyzed.Results All 10 cases were endogenous type CSP,including 5 cases with slight bulge outward.The thickness of the lower segment of uterine anterior wall was 0.1-0.4 cm,and the initial serumβ-HCG level was 16 509-179 673 U/L.Each case accepted intracervical and/or ultrasound-guided intra-gestational MTX injection twice with a total dose of 100-150 mg.The serumβ-HCG level decreased to 1 724-43 486 U/L before uterine curettage.Massive hemorrhage occurred in 4 cases,of which conservative treatment was successfully in 2 cases,1 case underwent wedge resection of the ectopic pregnancy via laparotomy,while 1 case underwent uterine artery embolization.Among 6 times intracervical injection administration,except for 1 time with additional intra-gestational anhydrous alcohol injection,5 times were ineffective,whereas 14 times intra-gestational injection administration were effective,which serumβ-HCG decreased by 27.78%-89.00%,with the median declining rate of 65.96%.Conclusion For MTX combined with uterine curettage for treating CSP,intra-gestational injection is better than intracervical injection in decreasing serumβ-HCG,while ultrasound-guided gestational administration should be taken as the first choice.
作者
王春庆
张红霞
杨保军
宋海曼
程令刚
王立淑
WANG Chunqing;ZHANG Hongxia;YANG Baojun;SONG Haiman;CHENG Linggang;WANG Lishu(Department of Ultrasonography,Beijing Tian Tan Hospital,Capital Medical University, Beijing 100050,China;Department of Obstetrics and Gynecology, Beijing Tian Tan Hospital,Capital Medical University, Beijing 100050,China)
出处
《中国介入影像与治疗学》
CSCD
北大核心
2018年第10期581-585,共5页
Chinese Journal of Interventional Imaging and Therapy
关键词
妊娠
异位
氨甲蝶呤
刮宫术
超声检查
Pregnancy,ectopic
Methotrexate
Dilatation and curettage
Ultrasonography
