CAJ | 학술논문

目的：探讨超声导引下介入治疗在终止宫角妊娠中的价值。方法78例宫角妊娠患者，23例孕囊大部分位于子宫内，且宫壁肌肉层厚度≥4 mm，超声监护下行吸宫及人流术；55例孕囊或包块不易清除，注射甲氨蝶呤终止宫角妊娠，并随机分为两组。A组28例，甲氨蝶呤肌肉注射；B组27例，超声监测下孕囊或包块内穿刺抽液后注入甲氨蝶呤。结果23例吸宫及人流术患者，未出现穿孔和大出血，其中5例蜕膜残留超过15 mm。 A、B两组治疗后4，7，14 d血β-HCG较治疗前均下降（P＜0．05）；与A组比较，B组治疗后4，7，14 d血β-HCG下降（P＜0．05）。与治疗前比较，A组治疗后14 d包块直径逐渐缩小，B组治疗后4，7，14 d包块直径缩小，差异均有统计学意义（P＜0．05）。B组治疗后14 d包块直径较A组小（P＜0．05）。结论如果孕囊大部分位于子宫内，宫壁肌肉层厚度≥4 mm，采取超声监护下行吸宫及人流术是安全有效的，但是易残留。而超声监护下孕囊或包块内穿刺注入甲氨蝶呤较肌肉注射甲氨蝶呤疗效好。
목적：탐토초성도인하개입치료재종지궁각임신중적개치。방법78례궁각임신환자，23례잉낭대부분위우자궁내，차궁벽기육층후도≥4 mm，초성감호하행흡궁급인류술；55례잉낭혹포괴불역청제，주사갑안접령종지궁각임신，병수궤분위량조。A조28례，갑안접령기육주사；B조27례，초성감측하잉낭혹포괴내천자추액후주입갑안접령。결과23례흡궁급인류술환자，미출현천공화대출혈，기중5례세막잔류초과15 mm。 A、B량조치료후4，7，14 d혈β-HCG교치료전균하강（P＜0．05）；여A조비교，B조치료후4，7，14 d혈β-HCG하강（P＜0．05）。여치료전비교，A조치료후14 d포괴직경축점축소，B조치료후4，7，14 d포괴직경축소，차이균유통계학의의（P＜0．05）。B조치료후14 d포괴직경교A조소（P＜0．05）。결론여과잉낭대부분위우자궁내，궁벽기육층후도≥4 mm，채취초성감호하행흡궁급인류술시안전유효적，단시역잔류。이초성감호하잉낭혹포괴내천자주입갑안접령교기육주사갑안접령료효호。
Objective To explore the value of ultrasound-guided interventional treatment in terminating cornual pregnancy. Methods Seventy-eight patients with cornual pregnancy were studied. Twenty-three patients that gestational sac was in utero and muscle layer thickness of uterine wall was≥4 mm were performed ultrasound-guided uterine aspiration and artificial abortion. Fifty-five cases were performed termination of pregnancy by methotrexate injection. They were randomly divided into two groups, including group A (treated with methotrexate intramuscular injection, n=28) and group B (treated with methotrexate injection in gestational sac or mass after ultrasound-guided puncture and drainage, n=27). Results Twenty-three patients with uterine aspiration and artificial abortion had no perforation and bleeding, residual decidua was more than 15mm in 5 cases. In group A and B, serumβ-HCG at 4 d,7 d and 14 d after treatment was lower than that before treatment (P<0.05). Compared with group A, serum β -HCG at 4 d,7 d and 14 d after treatment decreased obviously in group B (P<0.05). Compared with before treatment, mass diameter reduced at 14 d after treatment in group A and reduced at 4 d,7 d and 14 d after treatment in group B (P<0.05) . 14 d after treatment, mass diameter in group B was smaller than that in group A (P<0.05). Conclusion If gestational sac is in utero and muscle layer thickness of uterine wall is ≥4 mm, it is safe and effective to perform ultrasound-guided uterine aspiration and artificial abortion, but it is easy to have residual decidua. The effect of ultrasound-guided puncture and methotrexate injection in gestational sac or mass is better than that of methotrexate intramuscular injection.