剖宫产术后子宫瘢痕部位妊娠96例临床分析  

Analysis of 96 cases with cesarean scar pregnancy

作　　者：张英[1] 陈义松[1] 王佳佳[1] 陆芝英[1] 华克勤[1] 

机构地区：[1]复旦大学附属妇产科医院产科 ,上海200011

出　　处：《中华妇产科杂志》2010年第9期664-668,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的 探讨剖宫产术后子宫瘢痕部位妊娠（CSP）的临床表现、诊断依据、治疗方法和卫生经济学特点.方法 回顾性分析复旦大学附属妇产科医院2005年1月至2008年12月收治的96例CSP患者的临床资料,按不同治疗方法分为A组33例,行甲氨蝶呤（MTX）50 mg/m2静脉滴注,其中18例MTX静脉治疗后5～10 d内行清宫术（MTX＋清宫）;15例先行清宫术,术后每48小时复查1次血人绒毛膜促性腺激素β亚单位（β-hCG）水平,3次均下降不足30%者,再用MTX 50 mg/m2静脉滴注治疗（清宫＋MTX）.B组60例,行MTX双侧子宫动脉介入栓塞治疗,每侧子宫动脉注入MTX 100 mg,术后2 d内行清宫术.C组3例,行子宫病灶切除术.比较各组出血量（M）、病灶直径（-x±s）、治疗前血β-hCG水平（M）、病灶距子宫浆膜层≤3mm的例数、病灶血流阻力指数（RI）≤0.5的例数、治疗费用（-x±s）、住院时间（-x±s）的差异,并分析出血量与病灶直径和血β-hCG水平的相关性.结果 （1）临床指标：出血量：A组MTX＋清宫者为20 ml、清宫＋MTX者为10 ml,B组为12 ml,C组为200ml,C组与A、B组比较,差异有统计学意义（P＜0.01）;病灶直径：A组MTX＋清宫者为（16±8）mm、清宫＋MTX者为（23±15）mm,B组为（30±14）mm,显著高于A组MTX＋清宫者,差异有统计学意义（P＜0.01）,C组为（52±7）mm,3组分别比较,差异均有统计学意义（P＜0.01）;治疗前血β-hCG水平：A组MTX＋清宫者为21 592 U/L、清宫＋MTX者为979 U/L,两者比较,差异有统计学意义（P＜0.05）,B组为11 312 U/L,C组为101 U/L,C组与A、B组比较,差异均有统计学意义（P＜0.05）;病灶血流RI0.5共28例,其中A组8例（24%,8/33）、B组18例（30%,18/60）,C组2例（2/3）,C组高于其他两组,差异有统计学意义（P＜0.05）;病灶距子宫浆膜层≤3 mm共23例：A组2例（6%,2/33）,B组21例（35%,21/60）,C组0例,B组高于其他两组,差异也有统计学意义（P＜0.05）Objective To investigate the clinical manifestation, diagnosis, therapies and medical economics of cesarean scar pregnancy （CSP）. Methods From Jan. 2005 to Dec. 2008, 96 patients with CSP treated in Obstetrics and Gynecology Hospital of Fudan University were studied retrospectively. Those cases were divided into 3 groups. Thirty-three patients were treated with methotrexate （MTX） 50 mg/m2 intravenously guttae in group A. Among that 18 cases were treated with MTX, after 5 - 10 days they underwent dilation and curettage of uterus; 15 cases were given by dilation and curettage first if the level of serum human chorionic gonadotrophin-β（β-hCG） descent less than 30% in every 48 hours for 3 times after curettage, then MTX （50 mg/m2） intravenously guttae. Sixty patients were treated with MTX 100 mg bilateral uterine artery injection and embolization in group B. After 2 days, they underwent curettage.Group C： 3 patients were treated with laparotomy lesion excision. The following clinical parameters were compared, including blood loss（ M）, lesion diameter （-x±s）, blood β-hCG level （M）before treatment, the number of cases with myometrial thickness anterior to the CSP ≤3 mm, the resistant index （RI） ≤0. 5,expense（-x ± s）, hospital days（-x ±s） in those 3 groups. The correlation of blood loss with lesion diameter and blood β-hCG level was studied. Results （ 1 ） Clinical manifestation： bleeding loss were 20 ml in MTX ＋curettage of group A, 10 ml in curettage ＋ MTX of group A, 12 ml in group B and 200 ml in group C. The volume of bleeding loss in group C was significantly higher than those in group A or group B （ P 〈 0. 01 ）.The lesion diameter were （ 23 ± 15 ） mm in curettage ＋ MTX of group A and （ 30 ± 14 ） mm of group B ,which were higher than （ 16 ± 8 ） mm of MTX ＋ curettage of group A （P 〈 0. 01 ）. The lesion diameter of （52 ± 7 ）mm in group C were significantly bigger than those in the other groups （ P 〈 0. 01 ）. The l

关 键 词：妊娠 异位 栓塞 治疗性 甲氨蝶呤 

分 类 号：R686[医药卫生—骨科学]