剖宫产术后子宫疤痕妊娠不同治疗方法的临床疗效分析  

Analysis of Clinical Effects of Different Treatments for Cesarean Scar Pregnancy

作　　者：张黎敏[1] 胡继芬[1] 罗新[2] 

机构地区：[1]福建医科大学附属第一医院妇产科,福州350005 [2]暨南大学附属第一医院妇产科

出　　处：《中华妇幼临床医学杂志（电子版）》2012年第6期633-636,共4页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

摘　　要：目的探讨剖宫产术后子宫疤痕妊娠(CSP)的各种治疗方法。方法选择2007年2月至2011年8月福建医科大学附属第一医院妇产科(11例)及暨南大学附属第一医院妇产科(4例)收治的CSP患者15例为研究对象。采用甲氨蝶呤(MTX)+米非司酮药物治疗/+超声监测下清宫术,子宫动脉栓塞术(UAE)和(或)超声监测下清宫术,妊娠病灶切除术+子宫疤痕修补术和子宫全切除术治疗CSP。比较4种术式治疗CSP的临床疗效(本研究遵循的程序符合福建医科大学附属第一医院和暨南大学附属第一医院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试对象的知情同意)。结果 MTX+米非司酮药物治疗/+超声监测下清宫术,UAE和(或)超声监测下清宫术,妊娠病灶切除术+子宫疤痕修补术和子宫全切除术4种术式的住院时间分别为(24.2±0.8)d,(10.2±1.3)d,(8.5±1.0)d,(11.0±0.0)d,组间比较,差异有统计学意义(P=0.001);血β-hCG水平降至正常时间分别为(42.5±1.2)d,(22.7±3.2)d,(13.2±1.0)d,(18±0.0)d,组间比较,差异有统计学意义(P=0.001);随访时间分别为(150.2±4.5)d,(65.4±4.3)d,(30.3±3.2)d,(30.0±0.0)d,组间比较,差异有统计学意义(P=0.001);治疗费用分别为(2321.3±32.5)元,(13320.2±85.9)元,(8985.2±68.6)元,(9985.5±0.0)元,组间比较,差异亦有统计学意义(P=0.001)。结论 CSP的治疗方式应采取个体化的原则。MTX+米非司酮药物治疗、UAE后不行或缓行清宫术,可能为安全有效的CSP治疗方法。积极行妊娠病灶切除可缩短治疗周期,疗效确切。Objective To discuss the clinical effects of different ways for cesarean scar pregnancy （CSP）. Methods From February 2007 to August 2011, 15 patients with CSP who recruited into First Affiliated hospital of Fujian Medical University （n=11） and First Affiliated Hospital of Jinan University （n=4） were reviewed retrospectively. The operation methods included four kinds of operation methods, MTX and Mifepristone/＋B ultrasonic guided curettage of uterine, uterine arterial embolism （UAE）/＋ B ultrasonic guided curettage of uterine, pregnancy lesion excision ＋uterine scar neoplasty, and hysterectomy. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of First Affiliated hospital of Fujian Medical University and First Affiliated Hospital of Jinan University. Informed consent was obtained from all participates′ parents. Results The duration of hospitalization of four kinds of operation methods （MTX and Mifepristone/＋B ultrasonic guided curettage of uterine, UAE/＋B ultrasonic guided curettage of uterine, pregnancy lesion excision ＋uterine scar neoplasty, and hysterectomy） were （24.2±0.8） d, （10.2±1.3） d,（8.5±1.0） d, （11.0±0.0） d, respectively, with significant differences （P=0.001）. The time of blood β-hCG level back to normal were （42.5±1.2）d,（22.7±3.2）d,（13.2±1.0）d,（18.0±0.0）d, respectively, with significant differences （P=0.001）. The follow-up time of four kinds of operation methods were （150.2±4.5） d, （65.4±4.3） d, （30.3±3.2） d, （30.0±0.0） d, respectively, with significant differences （P=0.001）. The treatment costs of four kinds of operation were （2321.3±32.5）Yuan, （13 320.2±85.9） Yuan, （8985.2±68.6） Yuan, （9985.5±0.0） Yuan, respectively, with significant differences （P=0.001）. Conclusions Different operation methods should be conducted according to different patient. MTX combined with Mifepristone, or UAE without curettage of uterine might be effecti

关 键 词：剖宫产术后子宫疤痕妊娠 治疗方法 

分 类 号：R719.8[医药卫生—妇产科学]