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目的探究米非司酮、局部注射甲氨蝶呤联合可视人工流产(人流)吸宫及Foley导尿管压迫止血保守治疗剖宫产瘢痕妊娠(CSP)的临床效果。方法 46例剖宫产瘢痕妊娠患者,根据治疗方案的不同分为治疗组和对照组,各23例。对照组患者予以米非司酮口服、甲氨蝶呤肌内注射,之后在可视人流机下行吸宫术;治疗组予以米非司酮片口服,同时在B超介导下行孕囊内注射甲氨蝶呤,吸宫术后常规用Foley导尿管球囊置宫腔局部压迫。比较在用药8 h后两组患者孕囊活性和用药后4 d、1周及2周时患者血清人绒毛膜促性腺激素(β-HCG)值及血β-HCG转阴时间,并对此患者术中、术后24 h阴道出血量及平均住院时间。结果治疗组患者用药后4 d、1周、2周的血β-HCG值及β-HCG转阴时间均明显少于对照组,差异均有统计学意义(P<0.05)。治疗组患者用药后孕囊活性降低率为52.2%及治疗成功率为100.0%,均高于对照组的17.4%和82.6%,差异均有统计学意义(P<0.05)。治疗组患者的术中、术后24 h阴道出血量及住院时间均明显少于对照组,差异均有统计学意义(P<0.05)。结论米非司酮、局部注射甲氨蝶呤联合可视人流吸宫及Foley导尿管压迫止血保守治疗剖宫产瘢痕妊娠临床效果显著,既能缩短保守治疗时间,又能降低清宫时出血风险,值得临床推广。
Objective To investigate the clinical effect of mifepristone, methotrexate combined with visual abortion (human flow) aspiration and Foley catheterization for the conservative treatment of cesarean scar pregnancy (CSP). Methods 46 cases of cesarean scar pregnancy were divided into treatment group and control group according to the different treatment options, each of 23 cases. Patients in the control group were given mifepristone orally, intramuscular injection of methotrexate, and then in the visual human flow machine downstream aspiration; the treatment group was given mifepristone tablets orally, at the same time in the B-mediated down gestational sac injection Methotrexate, suction after the conventional use of Foley catheter balloon intrauterine local compression. The levels of serum human chorionic gonadotropin (β-HCG) and blood β-HCG turning-over time were compared between the two groups after gestational sac activity and at 4 days, 1 week and 2 weeks after the medication for 8 h The intraoperative and postoperative 24 hours of vaginal bleeding and the average length of stay. Results The serum β-HCG and β-HCG negative time of the treatment group were significantly less than those of the control group at 4 d, 1 week and 2 weeks after treatment. The differences were statistically significant (P0.05). After treatment, the reduction rate of gestational sac in treatment group was 52.2% and the success rate was 100.0%, which were all higher than those in control group (17.4% vs 82.6%, P <0.05). The intraoperative and postoperative 24-hour vaginal bleeding volume and hospital stay in the treatment group were significantly less than those in the control group, with significant differences (P <0.05). Conclusion The clinical effect of mifepristone, local injection of methotrexate combined with visual abortion aspiration and Foley catheter embolization in the treatment of cesarean scar pregnancy is significant, which not only shortens the duration of conservative treatment but also reduces the risk of bleeding during the curettage , It is worth clinical promotion.