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目的评价米非司酮配合血β-HCG监测,治疗药物流产不全效果。方法 2008年3月至2011年2月,在妇科门诊行药物流产(孕36～49d)后阴道淋漓出血超过20d,B超证实有宫腔残留且血β-HCG≤200IU/ml的患者136例。根据患者意愿分为两组,治疗组78例,口服米非司酮25mg,2次/d,连服5d,停药复查血β-HCG、肝功。血β-HCG<10IU/ml或血β-HCG值下降大于50%,无阴道流血,停止治疗;血β-HCG未降至正常或下降大于50%伴阴道流血可再口服米非司酮25mg,2次/d,共5d;血β-HCG下降小于50%,或拒绝继续用药观察者,即行清宫术按无效计算。对照组42例,常规行清宫术。结果治疗组78例患者痊愈73例,其中服药2次13例(16.7%)。73例患者均在1～2月后月经恢复正常,总有效率93.6%。无效5例行清宫术,其中2例拒绝继续用药(1例病理结果为坏死的胎盘绒毛组织,1例病理结果为机化凝血块伴炎性细胞浸润);1例经后复查B超示宫腔残留,查血β-HCG<0.1IU/ml,清宫病理结果为增生期子宫内膜;2例血β-HCG下降小于50%,病理结果为坏死绒毛及蜕膜组织。对照组刮出物病理结果示:坏死蜕膜及绒毛组织37例(88.1%),其中伴细胞浸润2例,机化的血凝块伴炎细胞浸润4例(14.3%),分泌期伴增殖早期子宫内膜1例|(2.4%)。结论对于药物流产术后阴道流血淋漓不净者,通过β-HCG监测,给米非司酮辅以促宫缩、抗感染治疗,可以使大部分患者避免宫腔操作,减少子宫内膜的损伤,值得临床推广使用。
Objective To evaluate the efficacy of mifepristone in combination with β-HCG monitoring in the treatment of drug abortion. Methods From March 2008 to February 2011, vaginal dripping and bleeding in gynecology clinic were more than 20 days after gynecological abortion (from 36 to 49 days of gestation), and 136 patients with intrauterine residual blood β-HCG≤200IU / ml . According to the wishes of the patients were divided into two groups, the treatment group of 78 patients, oral mifepristone 25mg, 2 times / d, and even served 5d, withdrawal of blood β-HCG, liver function. Blood β-HCG <10IU / ml or blood β-HCG decreased more than 50%, no vaginal bleeding, stop treatment; blood β-HCG did not fall to normal or decreased more than 50% with vaginal bleeding can be repeated oral mifepristone 25mg , 2 times / d, a total of 5d; blood β-HCG decreased less than 50%, or refused to continue medication observer, that is, curettage by invalid calculation. Control group of 42 patients, routine curettage. Results In the treatment group, 78 patients were cured 73 cases, of which 13 cases (16.7%) were taken twice. All 73 patients returned to normal after 1 ~ 2 months with a total effective rate of 93.6%. Ineffective 5 routine curettage, of which 2 refused to continue medication (1 case of pathological results of necrosis of placental villi, 1 case of pathological results of coagulation with inflammatory cell infiltration); 1 case after the review of B- Residual cavity, check blood β-HCG <0.1IU / ml, pathological results of the proliferative endometrium; 2 cases of blood β-HCG decreased less than 50%, the pathological results of necrosis of the villi and decidua. In the control group, pathological findings of the scraped material showed that 37 cases (88.1%) of necrotic decidual and villus tissues, including 2 cases of infiltrating cells, 4 cases (14.3%) of inflammatory cells infiltrating with blood clots, and proliferative Early endometrium in 1 case | (2.4%). Conclusion For vaginal bleeding after medical abortion, those who have no vaginal bleeding can be monitored by β-HCG, which can help most patients avoid uterine cavity operation and reduce the damage of endometrium , It is worth to promote clinical use.