目的: 探讨甲氨蝶呤( Methotrexate，MTX) 联合清宫术终止停经7wk 以内Ⅱ－Ⅲ型剖宫产子宫瘢痕妊
娠( cesarean scar pregnancy，CSP) 的效果及出血风险。方法: 选取2013～ 01－2017～ 06 本院收治的CSP 病人74 例
为研究对象，根据随机数字表法随机分为观察组和对照组，每组各37 例。观察组采用MTX 联合清宫术治疗，对
照组仅采用清宫术治疗。比较两组治疗疗效、手术相关情况、随访相关情况以及术后生活质量。结果: 观察组治
疗总有效率为83．78%，显著高于对照组( P＜0．05) ; 观察组术中出血量、大出血发生率分别为56．27±14．34mL 和
0．00%，显著少于或低于对照组( P＜ 0．05) ，观察组阴道出血时间、住院时间以及住院费用分别为6．16± 1．25d、
14．73±4．36d 和4839±636d，显著短于或少于对照组( P＜0．05) ; 观察组包块消失时间、血β－HCG 恢复时间、月经
恢复时间、痊愈时间分别为28．47±4．89d、26．39±4．68d、43．37±6．22d 和50．83±8．23d，显著短于对照组( P＜0．05) ; 观
察组术后1mo 生活质量测定量表简表( WHOQOL－BＲEF) 各维度评分均显著高于对照组( P＜0．05) ，术后3mo 两
组WHOQOL－BＲEF 量表各维度评分差异无统计学意义( P＞0．05) 。结论: MTX 联合清宫术可有效提高停经7wk
以内Ⅱ－Ⅲ型CSP 治疗效果，降低出血风险，提高术后短期内生活质量。

Objective: To investigate the effects of methotrexate( MTX) combined with uterus curettage
for termination of type II－III cesarean scar pregnancy( CSP) within 7 weeks and risk of bleeding．
Methods: A total of 74 patients with CSP who were admitted to our hospital during the period from January
2013 to June 2017 were selected as subjects，and they were divided into the observation group and
the control group with 37 cases in each group by the random number table method． The observation
group were treated with MTX and uterus curettage，while the control group were treated with uterus curettage
alone．The curative effect， situation of operation and follow－up and postoperative quality of life
were compared between the two groups．Ｒesults: The total treatment effective rate of the observation
group( 83．78%) was significantly higher than that of the control group ( P ＜ 0．05) ． The intraoperative
blood loss， the incidence of massive haemorrhage， time of vaginal bleeding，hospitalization time and hospitalization
expenses of the observation group( 56．27± 14．34mL，0．00%，6．16 ± 1．25d，14．73 ± 4．36d，
4839±636 yuan) were less /shorter than those of the control group( P＜0．05) ．The time of masses disappearing，
the recovery time of blood β－HCG， the recovery time of menstruation and the cure time of the
observation group( 28．47±4．89d，26．39±4．68d，43．37±6．22d，50．83±8．23d) were significantly shorter
than those of the control group( P＜0．05) ．The scores of quality of life scale( WHOQOL－BＲEF) in the
observation group were significantly higher than those in the control group at 1month after operation( P＜
0．05) ，but there was no significant difference between the two groups at 3months after operation( P＞
0．05) ．Conclusion: MTX combined with uterus curettage can effectively improve the curative effect of
type II－III CSP within 7 weeks after menopause， reduce the risk of bleeding and improve the quality of
life in a short term after operation．

Ｒ719．8