Analysis Of Curative Effect Of MTX Combined With Hysterectomy In The Treatment Of Type ? Scar Pregnancy With Different Approaches

ObjectiveTo analyze and compare the clinical effect of ultrasound-guided hysterectomy with intravesical injection of methotrexate and uterine artery embolization with methotrexate in the treatment of type ? uterine scar pregnancy.Methods From October 2016 to October 2018,96 pregnant women with type ? uterine scar were randomly divided into two groups,48 patients in the experimental group(partial injection of methotrexate into pregnancy sac).48 patients in control group(uterine artery embolization)were treated with methotrexate combined with hysterectomy to treat type ? uterine scar pregnancy.The focus clearance rate,surgical success rate,intraoperative and postoperative vaginal bleeding,the decrease of serum?-human chorionic gonadotropin(?-hCG)after discharge,the length of stay in hospital,the complications during and after operation,and so on,were analyzed.To analyze and compare the clinical effect of direct intravesical injection of methotrexate and uterine artery embolization with methotrexate on type ? cicatricial pregnancy of cesarean section.Results1.A total of 48 subjects in the experimental group were collected,of which 10 cases had vaginal bleeding more than 200 milliliters during and after operation,and 6 of them had vaginal bleeding more than 500 milliliters during and after operation.Among them,3 cases had vaginal bleeding more than 1000 milliliters during and after operation,and 6 of them underwent emergency laparotomy for hysterectomy due to the failure of curettage.The average hospitalization days for all subjects were 9.65 days.2.A total of 48 subjects were collected in the control group,of which 14 cases had vaginal bleeding more than 200 ml during and after operation,and 14 of them had vaginal bleeding more than 500 ml during and after operation.Among them,6 cases had vaginal bleeding more than 1000 milliliters during and after operation,and 3 of them underwent emergency laparotomy for hysterectomy due to the failure of curettage.The average hospitalization days of all subjects were 13.75 days.3.The serum levels of human chorionic gonadotropin(HCG)were decreased in all patients after operation.It took 15 to 30 days(average 22.6 days)for the experimental group to fall into the normal range,and the control group decreased to the normal range for 16 to 28days,and the control group decreased to the normal value for 16 to 28 days.An average of 21.71 days.4.There was no significant difference in intraoperative and postoperative vaginal bleeding between the two groups(c~2=0.89,p>0.05).Postoperative complications in both groups included"gastrointestinal reaction nausea and vomiting(c~2=0.10,p>0.05)"and"Oral ulcer(c~2=0.34,p>0.05)"."the level of serum?-human chorionic gonadotropin was not ideal after operation(c~2=2.18,p>0.05)"and"emergency operation(c~2=0.10,p>0.05)".There was no significant difference between the two groups.The results showed that there was no significant difference in postoperative complications between the two groups,indicating that methotrexate was injected into pregnancy capsule and methotrexate was infused into uterine artery,and there was no significant difference in efficacy between the two groups.The side effects were mainly related to the concentration of methotrexate.There was no significant correlation between the drug use and the route of drug use.Conclusion1.Ultrasound guided hysterectomy can effectively remove the lesions of type ? CSP,and it is an effective method for the treatment of scar pregnancy.2.Ultrasound-guided intravesical injection of methotrexate and intraarterial infusion of methotrexate after pre-treatment had no significant difference in the curative effect of uterine debridement on the study subjects,and there was no significant difference between intraoperative and postoperative complications.3.Considering the difference between the two kinds of treatment costs,and the requirement of uterine artery embolization to the hospital hardware and the technical ability of medical workers,it is suggested that the basic hospitals have a stable vital sign and the pregnancy sac is smaller by ultrasound.Patients with type ? scar pregnancy can give priority to ultrasound-guided intravesical injection of methotrexate and ultrasound-guided hysterectomy.Ultrasound has the advantages of non-invasive,non-radiation,simple operation and so on.The drugs are injected directly into the pregnancy sac.Kill embryos,reduce the risk of massive bleeding,short course of treatment,low cost.Interventional treatment of uterine artery embolization if necessary can effectively reduce the amount of bleeding,effectively avoid the adverse consequences of hysterectomy,retain the fertility of the patients,and improve the quality of life of the patients.