Department of Obstetrics and Gynecology, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Department of Ultrasonography, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Ther Clin Risk Manag. 2015 Jan 27;11:137-42. doi: 10.2147/TCRM.S76050. eCollection 2015.
To investigate the efficacy of methotrexate (MTX) injection in treatment of cesarean scar pregnancy (CSP).
A randomized controlled study was performed in 104 CSP patients receiving either local or systemic MTX injection at the Peking Union Medical College Hospital from the year 2008 to 2013.
Complete cure was defined as regression of ultrasonographic findings and normalization of serum β-hCG within 60 days. It was regarded as delayed cure if additional dilation and curettage (D&C) was needed. The overall cure rate (complete cure plus delayed cure) was 69.2% versus 67.3% for local injection versus systemic administration (P>0.05). The median time for serum β-hCG remission and uterine mass disappearance after systemic administration (42 [21-69] days and 40 [20-67] days) were significantly lower than those receiving local injection (56 [24-92] days and 53 [23-88] days), with P=0.029 and 0.046, respectively. The mean pretreatment serum β-hCG (human chorionic gonadotropin) level and lesion size in cured group (21,941±18,351 mIU/mL and 2.9±1.3 cm, respectively) were significantly lower than those in the failed group (37,047±30,864 mIU/mL and 3.6±1.3) with P=0.038 and 0.044, respectively.
MTX injection is effective in CSP treatment. Systemic administration shows similar overall cure rate compared to local injection, but requires shorter time for serum β-hCG remission and uterine mass disappearance.
探讨甲氨蝶呤（MTX）注射治疗剖宫产瘢痕妊娠（CSP）的疗效。
采用随机对照研究，选取 2008 年至 2013 年在北京协和医院接受局部或全身 MTX 注射治疗的 104 例 CSP 患者。
完全治愈定义为超声检查结果消退和血清β-hCG 在 60 天内正常化。如果需要额外的扩张和刮宫（D&C），则认为是延迟治愈。局部注射与全身给药的总治愈率（完全治愈加延迟治愈）分别为 69.2%和 67.3%（P>0.05）。全身给药后血清β-hCG 缓解和子宫肿块消失的中位数时间（42[21-69]天和 40[20-67]天）明显低于局部注射（56[24-92]天和 53[23-88]天），P 值分别为 0.029 和 0.046。治愈组（21941±18351 mIU/mL 和 2.9±1.3 cm）的预处理血清β-hCG（人绒毛膜促性腺激素）水平和病变大小明显低于未治愈组（37047±30864 mIU/mL 和 3.6±1.3），P 值分别为 0.038 和 0.044。
MTX 注射治疗 CSP 有效。全身给药与局部给药的总治愈率相似，但血清β-hCG 缓解和子宫肿块消失的时间更短。
