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目的研究联合应用清宫术与甲氨蝶呤(MTX)治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床效果。方法回顾性分析2012年1月至2014年1月子宫瘢痕妊娠38例患者的临床资料,观察组32例给予甲氨蝶呤及清宫术,其中A组12例给予甲氨蝶呤20 mg静脉滴注,B组10例局部注射甲氨蝶呤50 mg/m2,C组10例给予甲氨蝶呤50 mg/m2,深部肌肉注射;对照组6例给予子宫动脉栓塞术及清宫术或残留组织自行吸收治疗。观察各组治疗效果。结果 38例均有效保留子宫,三种用药方式疗效相似。对照组栓塞后约14 d血β-HCG值即降到正常水平,子宫切口残留的妊娠组织约60 d被完全吸收。结论清宫术联合甲氨蝶呤治疗子宫瘢痕妊娠安全、有效,局部给药方案可缩短疗程。
Objective To study the clinical effect of combined use of curettage and methotrexate (MTX) in the treatment of uterine scar pregnancy (CSP) after cesarean section. Methods The clinical data of 38 patients with uterine scar pregnancy from January 2012 to January 2014 were retrospectively analyzed. Methotrexate and oxytocin were given to 32 patients in the observation group, and 12 patients in group A received methotrexate 20 mg intravenously Note: Methotrexate 50 mg / m2 was given to 10 patients in group B and methotrexate 50 mg / m2 in group C, and deep intramuscular injection was given in group B. 6 patients in control group were given uterine arterial embolization and radical surgery or residual tissue Self-absorption treatment. Observed the treatment effect of each group. Results 38 cases were effective retention of the uterus, three kinds of medication similar efficacy. In the control group, the blood β-HCG value dropped to the normal level about 14 d after embolization, and the residual pregnant tissue in the uterine incision was completely absorbed in about 60 d. Conclusions The combination of curettage and methotrexate in the treatment of uterine scar pregnancy is safe and effective, and the local administration can shorten the course of treatment.