摘要
目的探讨甲氨蝶呤(MTX)肌注及高强度聚焦超声(HIFU)预处理后行宫腔镜治疗子宫瘢痕妊娠(CSP)在预后及再生育方面的差异.方法回顾性分析2016年1月至2018年12月54例CSP患者的临床资料,依据治疗方法分为HIFU组(25例)和MTX组(29例),预处理后均行宫腔镜清宫术治疗,比较两组患者术中出血量、术后血人绒毛膜促性腺激素(β-hCG)的变化、住院时间及费用、血β-hCG恢复正常时间、月经恢复时间以及电话随访相关生育结局,包括正常宫内妊娠、稽留流产、重复切口妊娠及不孕的发生率,以及术后从未避孕至首次宫内妊娠的发生时间.结果两组患者术后血HCG变化、出血量、血HCG及月经恢复正常时间差异无统计学意义(P>0.05),住院天数MTX组多于HIFU组,住院总费用HIFU组多于MTX组(P<0.05).两组患者术后再生育情况差异无统计学意义(P>0.05),但HIFU组首次妊娠时间较MTX组早,1年半内HIFU组宫内妊娠率80%,而MTX组37.5%.结论MTX及HIFU作为宫腔镜治疗CSP术前预处理是安全有效的,两者在预后及远期再生育情况无明显差异,MTX联合宫腔镜治疗CSP更加经济,但对于近期生育愿望急迫的患者宫腔镜术前进行HIFU预处理是首选.
Objective To investigate the difference of prognosis and reproduction of incision pregnancy treated by hysteroscopy after methotrexate intramuscular injection and high intensity focused ultrasound.Methods The clinical data of 54 patients with CSP admitted to our hospital from January 2016 to December 2018 were retrospectively analyzed.According to the treatment methods,they were divided into HIFU group(25 cases)and MTX group(29 cases).Hysteroscopic electrotomy were performed after pretreatment.The prognosis of the two groups was compared,such as intraoperative bleeding volume,changes of human chorionic gonadotropin(P-hCG)in blood after operation,hospitalization time,cost,recovery time of blood p-hCG,menstrual recovery time and telephone follow-up related fertility outcomes,including normal intrauterine pregnancy,missed abortion,repeated incision pregnancy and infertility,and the time of the first intrautenne pregnancy after operation.Results There was no significant difference in age,pregnancy times,cesarean section times,menopause time,preoperative blood HCG and the thickness of gestational sac from serosa layer between the two groups(P>0.05);there was no significant difference in the changes of serum HCG,blood loss,the time of recovery of P-HCG and menstruation,between HIFU and MTX groups after operation(P>0.05),and the days of hospitalization in MTX group were longer(P>0.05).The total cost of HIFU group was higher than MTX group(P<0.05).There was no significant difference in reproductive status between the two groups(P>0.05),but the time of first pregnancy in HIFU group was earlier,the intrauterine pregnancy rate in HIFU group was 80%within one and a half years,compared with 37.5%in MTX group.Conclusion MTX and HIFU are safe and effective as pretreatment for hysteroscopy in the treatment of CSP.There is no significant difference in prognosis and long-term reproductive status between them.MTX combined with hysteroscopy is more economical,but HIFU is the first choice for patients with urgent desire to have a baby.
出处
《浙江临床医学》
2020年第7期1012-1014,共3页
Zhejiang Clinical Medical Journal
基金
浙江省嘉兴市科技计划项目(2017BY18027)。
关键词
高强度聚焦超声
甲氨蝶呤
子宫瘢痕妊娠
再生育
High intensity focused ultrasound
Methotrexate
Incision pregnancy
Regeneration
