剖宫产术后切口妊娠82例临床分析

发布时间：2018-12-25 07:51

【摘要】：目的探讨甲氨喋呤(MTX)全身化疗后B超下清宫在切口妊娠治疗中的作用。方法 82例切口妊振患者分为两组:孕囊大部分突向宫腔组(A组,n=20)及孕囊主要侵入肌层组(B组,n=62),回顾性分析MTX肌肉或静脉注射后B超下清宫的成功率及其影响因素。结果 A组MTX静脉化疗4例B超下清宫均成功;肌肉注射MTX的16例中12例B超下清宫成功,4例因术中持续出血而行开腹手术。B组静脉化疗16例,14例B超下清宫成功,2例术后切口包块达浆膜而开腹;MTX肌肉化疗46例,42例B超下清宫成功,2例因术后切口处包块达浆膜层而开腹,另2例术中持续出血而开腹。MTX化疗后清宫手术成功率达87.80%。手术成功的72例与失败的10例治疗前血β-HCG水平之间差异有统计学意义(P0.05)。结论 MTX全身化疗配合B超下清宫是治疗切口妊娠简单有效的方法,其成功率与治疗前血β-HCG水平的高低有关。
[Abstract]:Objective to investigate the effect of systemic chemotherapy with methotrexate (MTX) (MTX) on pregnancy. Methods Eighty-two patients with pregnancy induced vibration by incision were divided into two groups: group A (group A, n = 20), group A (n = 20) and group B (group B, n = 62). The success rate and influencing factors of uterine clearance under B-ultrasound were analyzed retrospectively after intramuscular or intravenous injection of MTX. Results in group A, 4 cases of MTX intravenous chemotherapy were successfully cleared under B-ultrasound. Of the 16 cases injected intramuscularly with MTX, 12 cases were successfully cleared by B-ultrasound and 4 cases underwent open surgery due to continuous bleeding during operation. Group B received intravenous chemotherapy in 16 cases, and 14 cases under B-ultrasound. 46 cases were treated with MTX intramuscular chemotherapy, 42 cases were successfully cleared by B-ultrasound, 2 cases were opened due to incision mass reaching serous layer, and the other 2 cases underwent continuous bleeding during operation. The successful rate of uterine clearance was 87.80% after MTX chemotherapy. There was significant difference in serum 尾-HCG levels between 72 cases of successful surgery and 10 cases of failure before treatment (P0.05). Conclusion MTX systemic chemotherapy combined with B ultrasound to clear the uterus is a simple and effective method for the treatment of incision pregnancy. Its success rate is related to the level of serum 尾-HCG before treatment.
【作者单位】：华中科技大学同济医学院附属同济医院妇产科;
【分类号】：R714.22

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