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目的探讨超声引导下用甲氨蝶呤(MTX)局部注射+清宫治疗早期剖宫产瘢痕部位妊娠(CSP)的临床效果。方法收集2014年10月至2015年12月剖宫产瘢痕部位妊娠患者18例,经超声引导下瘢痕部位孕囊注射MTX,对其临床资料进行回顾性分析,并评估其疗效。结果 18例剖宫产瘢痕部位妊娠患者局部注射MTX后,血HCG均显著下降,7 d后孕囊周围血供明显减少。在超声引导下17例清宫顺利,术中出血20~200 ml不等,1例术中出现疤痕部位破裂改行开腹子宫局部病灶切除+子宫修补术,18例病例术后22~30 d血HCG恢复正常,复查B超瘢痕处未见残留。结论超声引导下局部注射MTX+清宫治疗早期瘢痕部位妊娠,操作简单,患者创伤较小,安全,不良反应较轻,治疗费用较低,保留女性生育能力,易被患者接受,对于瘢痕部位妊娠患者疗效明确。
Objective To investigate the clinical effect of ultrasound-guided local injection of methotrexate (MTX) and curettage in the treatment of early cesarean scar pregnancy (CSP). Methods Eighteen pregnant women with cesarean section scar were collected from October 2014 to December 2015. MTX was injected into the gestational sac of the scar site under the guidance of ultrasound. The clinical data of the patients were retrospectively analyzed and evaluated. Results 18 cases of cesarean scar pregnancy in patients with local injection of MTX, the blood HCG were significantly decreased, after 7 d, the blood supply around the gestational sac was significantly reduced. Under the guidance of ultrasound, 17 cases were successfully cured and 20 ~ 200 ml bleeding occurred. One case had rupture of the scar site and local open excision of the open laparotomy and uterine repair. In 18 cases, blood HCG Returned to normal, review B-scar no residue. CONCLUSIONS: Local injection of MTX + Qinggong under local anesthesia for the treatment of early scar pregnancy has the advantages of simple operation, less trauma, less risk of adverse reactions, lower cost of treatment, retention of female fertility and easy acceptance by patients. clear.