CAJ | 학술논문

目的：探讨剖宫产瘢痕妊娠(Cesarean scar pregnancy，CSP)行腹腔镜保守性手术联合术前使用甲氨蝶呤MTX的可行性及安全性。方法：将笔者所在医院2008年10月-至今收治Ⅱ型剖宫产瘢痕妊娠患者37例分为两组。A组18例术前给予甲氨蝶呤50~75 mg静脉注射，B组19例术前不使用甲氨蝶呤，仅进行腹腔镜下瘢痕处妊娠物清除术。随后对手术前后激素指标、术中出血量、手术时长等参数进行分析。结果：两组患者均保留生育功能治愈出院。A组手术过程中出血量明显低于B组，A组手术时间明显高于B组，两组比较差异均有统计学意义(P<0.05)。结论：腹腔镜保守性手术联合甲氨蝶呤治疗Ⅱ型剖宫产瘢痕妊娠具有创伤小、康复快的优点。在腹腔镜下可以对病情进行确诊，在瘢痕处妊娠物清除术的同时，也清除了与宫腔相连的腔隙与窦道，减少了再次发生CSP、胎盘植入的风险，值得推广。
목적：탐토부궁산반흔임신(Cesarean scar pregnancy，CSP)행복강경보수성수술연합술전사용갑안접령MTX적가행성급안전성。방법：장필자소재의원2008년10월-지금수치Ⅱ형부궁산반흔임신환자37례분위량조。A조18례술전급여갑안접령50~75 mg정맥주사，B조19례술전불사용갑안접령，부진행복강경하반흔처임신물청제술。수후대수술전후격소지표、술중출혈량、수술시장등삼수진행분석。결과：량조환자균보류생육공능치유출원。A조수술과정중출혈량명현저우B조，A조수술시간명현고우B조，량조비교차이균유통계학의의(P<0.05)。결론：복강경보수성수술연합갑안접령치료Ⅱ형부궁산반흔임신구유창상소、강복쾌적우점。재복강경하가이대병정진행학진，재반흔처임신물청제술적동시，야청제료여궁강상련적강극여두도，감소료재차발생CSP、태반식입적풍험，치득추엄。
Objective:To evaluate the feasibility and safety of Methotrexate before laparoscopic operation on type Ⅱcesarean scar pregnancy patients. Method:37 type Ⅱcesarean scar pregnancy patients from our hospital were randomly divided into two groups.Group A was intravenous injected 50-75 mg Methotrexate before operation,while group B was solely treated with laparoscopic operation.The parameters of operation result were analyzed with independent samples t-test.Result:Two groups of patients were reserved reproductive function and hospital cured.Compared with group B,bleeding volume during operation of group A were significantly reduced and operation duration of group A were significantly rised(P<0.05).Conclusion:It is effective and micro-traumatic to use of Methotrexate before laparoscopic operation on typeⅡcesarean scar pregnancy patients.The diagnosis conclusion can be confirmed with laparoscope observation, meanwhile the scar pregnancy and sinus tract connected to uterine cavity can be removed,which reduced the risk of recurrence of cesarean scar pregnancy and placenta accreta.This treatment is worth of popularizing.