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目的分析中药杀胚消症方辅助甲氨蝶呤联合治疗剖宫产后瘢痕妊娠的临床效果。方法选取98例剖宫产术后并发瘢痕妊娠妇女,采取抛掷硬币的方式进行随机分组,分为联合组49例、对照组49例,两组均采用宫颈孕囊及周围组织进行局部注射甲氨蝶呤(50 mg/m~2)进行杀胚治疗,联合组同时静滴杀胚消症方进行辅助治疗。结果联合组的一次杀胚成功率(77.6%)显著高于对照组(46.9%)(P<0.05),联合组的中转手术治疗率(10.2%)显著低于对照组(26.5%)(P<0.05)。联合组的β-hCG达标时间、阴道出血持续时间、子宫下段异常回声消失时间、月经复潮时间均显著低于对照组(P<0.05)。治疗后第7天、14天、28天联合组患者的β-hCG水平均显著低于对照组(P<0.05)。联合组的腹痛发生率、恶心呕吐发生率、腹泻发生率、白细胞减少率、肝损害发生率与对照组比较,差异均不具有统计学意义(P>0.05)。结论中药杀胚消症方辅助甲氨蝶呤联合治疗剖宫产后瘢痕妊娠具有更高的临床成功率,能够更显著降低β-hCG水平及改善临床症状。
Objective To analyze the clinical effect of Chinese medicine killing embryo digestion prescription assisted methotrexate combined with cesarean section scar pregnancy. Methods Ninety-nine women with scar pregnancy after cesarean section were randomly divided into two groups: 49 cases in the combination group and 49 cases in the control group. Both groups were injected with the gestational sac of the cervix and the surrounding tissues, Pterin (50 mg / m ~ 2) was used to kill embryos, while the combination group was treated by intravenous injection of embryo digestion and disinfection. Results The success rate of killing one embryo (77.6%) in the combined group was significantly higher than that in the control group (46.9%) (P <0.05), and that in the combined group was significantly lower than that in the control group (10.2% vs 6.2% <0.05). The combined group of β-hCG compliance time, duration of vaginal bleeding, abnormal uterine segment echo disappearance time, menstrual recuperation time were significantly lower than the control group (P <0.05). The β-hCG levels in the combined group at 7, 14 and 28 days after treatment were significantly lower than those in the control group (P <0.05). The incidence of abdominal pain, the incidence of nausea and vomiting, the incidence of diarrhea, leukopenia and the incidence of liver damage in the combined group were not significantly different from those in the control group (P> 0.05). Conclusion Chinese medicine to kill embryo prescription side methotrexate combined with cesarean scar pregnancy has a higher clinical success rate, can significantly reduce the level of β-hCG and improve clinical symptoms.