剖宫产瘢痕妊娠79例个体化治疗临床分析  

Individualized therapy for caesrean scar pregnancy：79 cases

作　　者：张焱[1] 周怀君[1] 周航[1] 张姝[1] 

机构地区：[1]南京大学医学院附属鼓楼医院妇产科,江苏南京210008

出　　处：《徐州医学院学报》2015年第8期548-552,共5页Acta Academiae Medicinae Xuzhou

基　　金：国家自然科学基金青年科学基金（81300499）

摘　　要：目的：探讨剖宫产瘢痕妊娠（CSP）个体化治疗临床方案，分析不同治疗方法的临床结局。方法经阴道超声、彩色多普勒超声和血绒毛促性腺激素检查确诊 CSP患者79例，采用腹腔镜监护下或B超监护下清宫术（57例）、腹腔镜下或经腹妊娠病灶切除术（14例）、子宫动脉栓塞术（2例）和MTX＋息隐药物保守（6例）方法进行治疗，分析治疗效果。结果79例患者均完成手术或药物治疗，子宫切除率1．27％，治愈率100％。腹腔镜监护下清宫组与B超监护下清宫组术前一般情况及术中出血量差异无统计学意义，住院天数B超监护下清宫术组较腹腔镜监护下清宫术组长（P ＜0．05）；腹腔镜下妊娠病灶切除组与经腹妊娠病灶切除组术前一般情况及住院天数差异无统计学意义，术中出血量腹腔镜组大于开腹组（P ＜0．05）。结论根据病情选择个体化治疗方案能改善 CSP 患者的疗效和预后，病灶超声诊断对选择合理的手术方式有指导意义。Objective To discuss the individualized therapy of caesarean scar pregnancy （CSP） and corresponding clinical overcomes.Methods A total of 79 patients were included in the current study, who were diagnosed with caesar-ean scar pregnancy （CSP） through transvaginal ultrasonography, color doppler ultrasound and human chorionic gonado-tropin.They were treated with curettage of the uterine cavity guided by ultrasonography or laparoscopy （57 patients）, laparoscopic or transabdominal excision of scar tissues （14 patients）, uterine arterial embolization （2 patients） or a com-bination of MTX and mifepristone （6 patients）.Then, the therapeutic effectiveness was analyzed.Results All patients underwent surgery or drug therapy and cured, with a rate of hysterectomy of 1.27%.No statistical difference was ob-served as to the general condition before surgery and the amount of bleeding during surgery between patients receiving cu-rettage of the uterine cavity guided by ultrasonography or laparoscopy.The duration of hospitalization was longer for pa-tients guided by ultrasonography than those by laparoscopy （P 〈0.05）.Patients who underwent transabdominal excision of scar tissues produced a higher amount of bleeding than those treated with laparoscopic excision （P 〈0.05）, with no significant difference as to the general condition before surgery and the duration of hospitalization.Conclusion Based on the condition of each patient, individualized therapy can improve the effectiveness and prognosis in CSP patients.The ul-trasonographic diagnosis is instructive for determination of a rational operation.

关 键 词：剖宫产瘢痕妊娠 超声检查 临床方案 治疗结果 

分 类 号：R714.22[医药卫生—妇产科学]