CAJ | 학술논문

目的：观察甲氨蝶呤不同给药途径治疗子宫切口妊娠的临床疗效。方法选取2010年2月至2013年2月收治的子宫切口妊娠患者60例，随机分为A组和B组，A组患者肌肉注射全身给药，B组患者子宫动脉局部给药。观察两组治疗前后超声学声像变化，比较临床效果并记录不良反应。结果超声学结果显示，与治疗前比较，两组治疗后妊娠物显著缩小（ P＜0.05），前壁下段肌层厚度、血流阻力指数（RI）显著升高（ P＜0.05），且B组更明显（ P＜0.05）；B组转子宫切除术率、清宫术前治疗时间、术中出血量、术后住院时间、β－HCG降至正常时间均明显低于或短于A组（ P＜0.05）；B组不良反应总发生率明显低于A组（ P＜0.05）。结论甲氨蝶呤对子宫切口妊娠的临床疗效显著，经子宫动脉局部给药的效果优于经肌肉注射全身给药。与全身给药比较，局部给药具有保守治疗时间短、转子宫切除术率低、术后住院时间短、不良反应小等优点，值得临床推广。
목적：관찰갑안접령불동급약도경치료자궁절구임신적림상료효。방법선취2010년2월지2013년2월수치적자궁절구임신환자60례，수궤분위A조화B조，A조환자기육주사전신급약，B조환자자궁동맥국부급약。관찰량조치료전후초성학성상변화，비교림상효과병기록불량반응。결과초성학결과현시，여치료전비교，량조치료후임신물현저축소（ P＜0.05），전벽하단기층후도、혈류조력지수（RI）현저승고（ P＜0.05），차B조경명현（ P＜0.05）；B조전자궁절제술솔、청궁술전치료시간、술중출혈량、술후주원시간、β－HCG강지정상시간균명현저우혹단우A조（ P＜0.05）；B조불량반응총발생솔명현저우A조（ P＜0.05）。결론갑안접령대자궁절구임신적림상료효현저，경자궁동맥국부급약적효과우우경기육주사전신급약。여전신급약비교，국부급약구유보수치료시간단、전자궁절제술솔저、술후주원시간단、불량반응소등우점，치득림상추엄。
Objective To observe the clinical effect of different administration routes of methotrexate for treating cesarean scar pregnan-cy. Methods 60 cases of cesarean scar pregnancy in our hospital from February 2010 to February 2013 were selected and randomly divided into the group A and B. Methotrexate was given by intramuscular injection in the group A and the group B by uterine arterial topical administration in the group B, respectively. The changes of ultrasonic acoustic images before and after treatment were observed in the two groups. The clinical effects after treatment were compared between the two groups. The adverse reactions were recorded. Results The ultrasonic results showed that the pregnancy tissue after treatment was shrunk compared with before treatment ( P<0. 05 ) , while the muscular thickness in the inferior segment of anterior wall and RI were significantly increased ( P<0. 05 ) , moreover which in the group B was more significant ( P<0. 05 );the rate of conversion to hysterectomy, treatment time before complete curettage of uterine cavity, in-traoperative blood loss, postoperative hospital stay, time of β-HCG dropping to normal level in the group B were lower or shorter than those in the group A ( P<0. 05 );the occurrence rate of adverse reactions in the group B was significantly lower than that in the group A. Conclusion Methotrexate has obvious clinical effect in treating cesarean scar pregnancy. The curative effect of uterine artery topical administration is better than that by the intramuscular injection. Compared with the systemic administration, the topical administration has the advantages of the short conservative treatment time, low rate of conversion to hysterectomy compare with the intramuscular injection treatment of short time, low transfer rate of hysterectomy, shorter postoperative hospitalization time and little adverse reactions and de-serves to be clinically promoted.