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中华妇幼临床医学杂志(电子版) ›› 2017, Vol. 13 ›› Issue (03) : 358 -363. doi: 10.3877/cma.j.issn.1673-5250.2017.03.021

所属专题： 文献；

论著

超声引导下联合用药精准治疗子宫瘢痕妊娠的疗效分析
孔德姣1, 董晓秋1,†(), 戚云峰1, 张立维1   
  1. 1. 150001　黑龙江，哈尔滨医科大学附属第四医院
  • 收稿日期:2017-01-20 修回日期:2017-04-24 出版日期:2017-06-01
  • 通信作者: 董晓秋

Efficacy analysis of ultrasonography-guided combined drug therapy for cesarean scar pregnancy

Dejiao Kong1, Xiaoqiu Dong1,†(), Yunfeng Qi1, Liwei Zhang1   

  1. 1. Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
  • Received:2017-01-20 Revised:2017-04-24 Published:2017-06-01
  • Corresponding author: Xiaoqiu Dong
  • About author:
    Corresponding author: Dong Xiaoqiu, Email:
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孔德姣, 董晓秋, 戚云峰, 张立维. 超声引导下联合用药精准治疗子宫瘢痕妊娠的疗效分析[J]. 中华妇幼临床医学杂志(电子版), 2017, 13(03): 358-363.

Dejiao Kong, Xiaoqiu Dong, Yunfeng Qi, Liwei Zhang. Efficacy analysis of ultrasonography-guided combined drug therapy for cesarean scar pregnancy[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(03): 358-363.

目的

探讨超声引导下联合用药精准治疗子宫瘢痕妊娠(CSP)的临床价值。

方法

选择2010年1月至2016年1月于哈尔滨医科大学附属第四医院接收超声引导下联合用药精准治疗的20例CSP患者为研究对象。CSP患者在彩色多普勒超声引导下采用"三步治疗法"进行精准的介入治疗。观察患者治疗前、后血清β-人绒毛膜促性腺激素(hCG)水平、病灶体积、病灶周边血流分级等指标。本研究遵循的程序符合哈尔滨医科大学附属第四医院人体试验委员会制定的伦理学标准，征得患者本人的同意，并与之签署临床研究知情同意书。

结果

①治疗后CSP患者血清β-hCG水平持续下降，降至正常水平的时间为(39.8±10.5) d，治疗前血清β-hCG水平和治疗后第7、14、21、28、35天血清β-hCG水平整体比较，差异有统计学意义(Z＝39.0，P<0.001)。②治疗后病灶体积呈持续下降趋势，病灶消失时间中位数为31 d，治疗前病灶体积和治疗后第7、14、21、28、35天时病灶体积整体比较，差异有统计学意义(Z＝39.0，P<0.001)。③治疗后病灶周边血流分级持续下降。CSP患者治疗后病灶周边血流分级较治疗前明显下降，并且差异有统计学意义(Z＝6.0，P<0.001)。

结论

超声引导下联合用药精准治疗CSP可有效杀死胚胎，加快血清β-hCG水平下降速率，促进病灶快速吸收，是值得推广应用的简便、适用的新技术。

关键词: 妊娠，异位, 超声检查，介入性, 药物疗法，联合
Objective

To explore the clinical value of ultrasonography-guided combined drug therapy for cesarean scar pregnancy (CSP).

Methods

From January 2010 to January 2016, a total of 20 CSP patients who were admitted to the Fourth Affiliated Hospital of Harbin Medical University were included into this study. All of them received ultrasonography-guided combined therapy for CSP. The serum β-human chronic gonadotropin (hCG) levels, lesion volumes and blood flow classification around the lesions were observed before and after the treatment. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Fourth Affiliated Hospital of Harbin Medical University. Informed consent was obtained from the parents of each participating patients.

Results

①The mean serum β-hCG levels continued to decrease after the treatment, and the median duration of serum β-hCG retuned to was (39.8±10.5) d. There was significant difference in serum β-hCG levels before and after the treatment(Z=39.0, P<0.001). ②After the treatment, lesion volumes reduced and the median number of days for the masses to disappear was 31 days. There was significant difference in lesion volumes before and after the treatment (Z=39.0, P<0.001). ③The blood flow classification around the lesions continued to decrease after the treatment. There was significant difference of blood flow classification before and after the treatment (Z=6.0, P<0.001).

Conclusions

Ultrasonography-guided combined drug therapy for CSP can effectively kill the embryo, accelerate the decline rate of serum β-hCG levels, promote the rapid absorption of lesions, and provide a simple and applicable new technology for clinical application.

Key words: Pregnancy, ectopic, Ultrasonography, interventional, Drug therapy, combination
图1 介入治疗前、后子宫瘢痕妊娠患者经阴道彩色多普勒超声图像(图1A：超声引导下穿刺针进入妊娠囊；图1B：子宫瘢痕处可见妊娠囊及卵黄囊；图1C：妊娠囊内可见原始心管搏动；图1D：治疗后第28天病灶消失)
表1 血清β-人绒毛膜促性腺激素水平及病灶体积在治疗前、后不同时间点比较[M(最小值～最大值)]
不同时间点 例数 血清β-hCG水平(mIU/mL) 病灶体积(cm3)
治疗前 20 40 805(4 100～123 720) 7.00(3.00～26.00)
治疗后 20 ? ?
? 第3天 ? 35 525(21 680～68 395) 7.75(4.07～16.93)
? 第7天 ? 13 975(7 165～27 660) 4.60(1.76～12.59)
? 第14天 ? 5 465(1 424～10 450) 2.26(1.09～5.30)
? 第21天 ? 1 003(639～2 740) 0.85(0.29～2.47)
? 第28天 ? 215(152～760) 0.18(0～0.82)
? 第35天 0(0～7) 0(0～0)
Z值 ? 39.0 39.0
P值 <0.001 <0.001
表2 治疗前、后病灶周边血流分级比较[例数(%)]
不同时间点 例数 0级 Ⅰ级 Ⅱ级 Ⅲ级
治疗前 20 0(0) 0(0) 8(40.0) 12(60.0)
治疗后 20 8(40.0) 10(50.0) 2(10.0) 0(0)
Z值 ? 6.0
P值 ? <0.001
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