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目的探讨术前甲氨喋呤(MTX)静脉滴注和经子宫动脉栓塞给药对行宫腔镜手术剖宫产术后瘢痕妊娠(CSP)患者出血量、血β-hCG水平及围手术期并发症的影响。方法选取CSP患者100例,采用随机数字表法分为A组(50例)和B组(50例),分别在宫腔镜术前采用MTX静脉滴注与经子宫动脉栓塞给药治疗;比较两组患者术中和术后出血量、血β-hCG水平和月经复常时间,治疗前后瘢痕妊娠病灶直径及围手术期并发症发生率等。结果 B组患者术中和术后出血量均显著少于A组(P<0.05);B组患者血β-hCG水平和月经复常时间均显著短于A组(P<0.05);B组患者宫腔镜术前瘢痕妊娠病灶直径显著短于A组(P<0.05);B组患者手术前后血β-hCG水平显著低于A组(P<0.05);同时B组患者围手术期并发症发生率明显低于A组(P<0.05)。结论相较于静脉滴注给药,MTX经子宫动脉栓塞给药用于治疗宫腔镜手术CSP,可显著减少围手术期出血量,促进血β-hCG水平和月经复常,有助于降低相关并发症发生风险。
Objective To investigate the effect of preoperative MTX infusion and uterine arterial embolization on the blood loss, blood β-hCG level and perioperative complications in patients with cesarean scar after cesarean section under cesarean section The impact of disease. Methods 100 patients with CSP were divided into group A (n = 50) and group B (n = 50) by random number table. MTX and uterine arterial embolization were used before hysteroscopy. Intraoperative and postoperative blood loss, blood β-hCG levels and menstruation recanalization time, scar pregnancy pregnancy diameter and perioperative complications rate were compared between the two groups. Results The blood loss in group B was significantly less than that in group A (P <0.05). The level of β-hCG and the recurrence of menstruation in group B were significantly shorter than those in group A (P <0.05) The diameter of the lesion before hysteroscopic preoperative scar pregnancy was significantly shorter than that of group A (P <0.05); the level of β-hCG in group B was significantly lower than that of group A before and after operation (P <0.05); at the same time, the patients in group B had perioperative complications The incidence of disease was significantly lower than that of group A (P <0.05). Conclusion Compared with the intravenous drip, MTX administered by uterine artery embolization for the treatment of CSP hysteroscopic surgery can significantly reduce perioperative bleeding, promote blood levels of β-hCG and menstruation, is helpful to reduce Relevant complications occur at risk.