Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; The Rappaport Faculty of Medicine, The Technion Institute of Technology, Haifa, Israel.
Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; The Rappaport Faculty of Medicine, The Technion Institute of Technology, Haifa, Israel.
Eur J Obstet Gynecol Reprod Biol. 2019 Jul;238:138-142. doi: 10.1016/j.ejogrb.2019.05.014. Epub 2019 May 20.
To report the efficacy of combined systemic and local methotrexate treatment for cesarean scar pregnancy and review data from selected, similar case series.
A retrospective case series of 12 patients with cesarean scar pregnancy treated in a university hospital between 2014 and 2018. The intervention was combined treatment of systemic and local methotrexate.
Twelve patients were treated with combined systemic and local methotrexate. Clinical characteristics, clinical course and treatment efficacy were evaluated. Mean gestational age at diagnosis was 7.5 weeks (range 5.9-9.1). βhCG levels at diagnosis ranged from 1581 to 345,427 U/L with a mean of 77,795 U/L. All 12 patients were successfully treated without surgical intervention and with no significant side-effects. Mean hospitalization duration was 9 days (5.8-12.6) and mean time to normalization of βhCG levels was 98 days (63-132).
Treatment of cesarean scar pregnancy with a combination of systemic and local methotrexate was effective and safe. Although the treatment course tends to be longer than with other modalities, this protocol offers excellent success rates, with fertility preservation and few complications.
报告联合全身和局部甲氨蝶呤治疗剖宫产瘢痕妊娠的疗效，并回顾选定的类似病例系列数据。
对 2014 年至 2018 年期间在一家大学医院治疗的 12 例剖宫产瘢痕妊娠患者进行回顾性病例系列研究。干预措施为全身和局部甲氨蝶呤联合治疗。
12 例患者接受了全身和局部甲氨蝶呤联合治疗。评估了临床特征、临床过程和治疗效果。诊断时的平均妊娠龄为 7.5 周（范围 5.9-9.1）。诊断时βhCG 水平从 1581 到 345427 U/L，平均值为 77795 U/L。所有 12 例患者均成功治疗，无需手术干预，且无明显副作用。平均住院时间为 9 天（5.8-12.6），βhCG 水平正常化的平均时间为 98 天（63-132）。
联合全身和局部甲氨蝶呤治疗剖宫产瘢痕妊娠是有效且安全的。虽然治疗过程比其他方法长，但该方案具有出色的成功率，可保留生育能力，并发症较少。
