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目的:探讨子宫动脉栓塞、甲氨蝶呤及活血化瘀中药联合疗法治疗胎盘植入的临床疗效和安全性。方法:选取本院收治的胎盘植入患者64例,随机分为两组;对照组32例,以子宫动脉栓塞术加甲氨蝶呤进行治疗;观察组32例,在子宫动脉栓塞术加甲氨蝶呤的基础上口服活血化瘀中药;对比两组患者的近远期治疗效果。结果两组患者术后均有少量阴道出血,平均出血量无统计学差异(P>0.05);但观察组患者的HCG降低速度显著优于对照组(P<0.05),胎盘血流信号消失时间明显缩短(P<0.05)。观察组术后胎盘自行排出12例(37.5%)、清宫手术19例(59.4%)、摘除子宫1例(3.13%);对照组术后胎盘自行排出5例(15.6%)、清宫手术20例(62.5%)、摘除子宫7例(21.8%);观察组的自行排出率和保宫率均显著高于对照组(P<0.05)。此外,两组患者均无肝肾异常、骨髓抑制等严重不良反应,仅对照组4例、观察组6例胃肠道反应,对症治疗后缓解;随访2~6个月,保留子宫患者生理周期均恢复正常,B超复查子宫形态良好、无植入光团或异常肌层结构。结论:子宫动脉栓塞、甲氨蝶呤及活血化瘀中药联合疗法治疗胎盘植入疗效确切、保宫率高、并发症少,值得临床推广。
Objective: To investigate the clinical efficacy and safety of uterine artery embolization, combination therapy of methotrexate and traditional Chinese medicine in the treatment of placenta accreta. Methods: Sixty-four patients with placenta accreta admitted to our hospital were randomly divided into two groups. Control group (n = 32) was treated with uterine artery embolization plus methotrexate. The observation group (n = 32) On the basis of methotrexate oral blood circulation of Chinese medicine; compared two groups of patients with short-term treatment effect. Results There was a small amount of vaginal bleeding after operation in both groups, with no significant difference in the average amount of bleeding (P> 0.05). However, the reduction rate of HCG in the observation group was significantly better than that of the control group (P <0.05) Significantly shortened (P <0.05). There were 12 cases (37.5%) in the observation group, 19 cases (59.4%) in the operation of Qing Dynasty and 1 case (3.13%) in the uterus. The placenta in the control group were discharged by themselves in 5 cases (15.6% (62.5%), removal of the uterus in 7 cases (21.8%); the observation group of spontaneous discharge rate and Pauling rate were significantly higher than the control group (P <0.05). In addition, the two groups of patients had no serious adverse reactions such as liver and kidney abnormalities, bone marrow suppression, only the control group of 4 patients, the observation group of 6 patients gastrointestinal reactions, symptomatic treatment relief; follow-up of 2 to 6 months, retaining the uterine physiological cycle All returned to normal, B-ultrasound examination of the uterus in good shape, no implantation of light mass or abnormal muscle structure. Conclusion: Uterine artery embolization, methotrexate and traditional Chinese medicine combined therapy of activating blood circulation and placenta accreta for the treatment of placenta accreta has the exact effect, high rate of palace preservation and few complications, which is worthy of clinical promotion.