Clinical efficacy and safety of hysteroscopy surgery combined with methotrexate for treating the patients with cesarean scar pregnancy / 中国医师进修杂志

ABSTRACT

Objective To investigate the clinical efficacy and safety of hysteroscopy surgery combined with methotrexate (MTX) for treating the patients with cesarean scar pregnancy(CSP).Methods The clinical data of 64 patients with CSP were retrospectively analyzed.The patients were divided into observation group (46 cases) and control group (18 cases) according to treatment methods,the control group was given the therapy of local pregnancy intracapsular MTX combined with uterine curettage,and the observation group was given the therapy of local pregnancy intracapsular MTX combined with lesions removed surgery by hysteroscopy.The intraoperative blood Ioss,epistrophy time of β-human chorionic gonadotrophin (hCG),hospitalization time,clinical efficacy of the two groups were observed.Follow-up for 6 months the menstruation of the two groups was observed.Results The total effective rate in observation group was significantly higher than that in control group [100.0％ (46/46) vs.66.7％ (12/18),x2 =16.920,P ＜ 0.01].The intraoperative blood loss,epistrophy time of β-hCG and hospitalization time in observation group were significantly lower than those in control group [(35.46 ± 11.63) ml vs.(176.78 ± 57.96) ml,(21.04 ± 6.79)d vs.(39.65 ± 12.79) d,(13.89 ±4.63) d vs.(26.82 ±8.94) d,P＜0.01].The observation group had a successful surgery and no complications.In the control group,4 cases occurred uterine curettage intraoperative bleeding,2 cases underwent open lesion resection and then were forced to line hysterectomy.The rate of menstruation in observation group after operation 30-39 d was significantly higher than that in control group [84.8％ (39/46) vs.25.0％ (4/16),P ＜ 0.01].Conclusions Hysteroscopy surgery combined with MTX for treating the patients with CSP has exact clinical effect.It is safe and reliable,and is worthy of promotion and application.