不同方法治疗子宫切口瘢痕妊娠的临床效果分析  

Clinical analysis of different treatments on cesarean scar pregnancy

作　　者：尹保娜 史惠蓉[1] 

机构地区：[1]郑州大学第一附属医院妇产科,河南郑州450052 [2]焦作市妇幼保健院妇科,河南焦作454150

出　　处：《中国计划生育和妇产科》2014年第2期35-38,共4页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的观察不同方法治疗子宫切口瘢痕妊娠(cesarean scar pregnancy,CSP)的临床效果。方法将111例CSP患者分为4组,分别采用甲氨蝶呤(methotrexate,MTX)全身用药、MTX局部注射、子宫动脉栓塞、手术治疗,分析监测治疗后1周血人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)情况及转阴时间,观察治疗期间阴道出血情况及不良反应、治疗后包块超声影像变化,分析住院天数、住院费用及治愈率。结果手术治疗血HCG下降最快,住院时间、包块消失时间及HCG转阴时间最短,子宫动脉栓塞治疗次之,与MTX全身用药组比较差异均有统计学意义(P<0.05);MTX局部注射对孕囊型的疗效明显优于团块型;子宫动脉栓塞治疗费用最高。结论 CSP的治疗应实行个体化治疗,MTX局部注射可作为孕囊型患者治疗的首选方法,子宫动脉栓塞治疗可作为团块型患者的首选治疗方法,对于保守治疗无效者可改行子宫病灶切除+修复术。Objective To observe the clinical effects of different treatments on cesarean scar pregnancy （CSP）. Methods 111 patients of CSP underwent respectively treated with methotrexate （MTX） systemic treatment, MTX local treatment, uterine artery embolization （UAE） and surgery. The level of serum [3 - human chorionic gonadotrophin （HCG） a week after treatment, the time of HCG normalization were monitored. The vaginal hemorrhage and complications, the changes of ultrasonic images were observed. The hospitalization time, expenses and cure rate were analyzed. Results It was found the shortest time in serum HCG decreasing, hospitalization, CSP mass disappearance and HCG normalization of patients with surgery. Patients with UAE was the next, significant differences were found compared to patients with MTX systemic treatment（P 〈 0. 05）. The effect of local MTX on patients with gestational sac was superior to those with asymmetrical mass, and the cost of UAE was the highest of a11. Conclusion The treatment of CSP should be individualized. MTX local treatment may be the preferred method for patients with gestational sac anti UAE for patients with asymmetrical mass, while the mass resection combined withuterine repair is a preferred choice for the patients with invalid conservative treatment.

关 键 词：子宫切口瘢痕妊娠 甲氨蝶呤 子宫动脉栓塞 

分 类 号：R714.22[医药卫生—妇产科学]