176例剖宫产疤痕部位妊娠治疗方式选择及预后分析  

Two treatment strategies in 176 cases with cesarean scar pregnancy:efficacy and clinical outcomes

作　　者：吕冰清[1] 谢熙[1] 刘超斌[1] 

机构地区：[1]福建省妇幼保健院福建省医科大学教学医院,福州350001

出　　处：《生殖与避孕》2016年第3期240-244,共5页Reproduction and Contraception

基　　金：福建省临床重点专科建设项目(闽卫科教2012149)

摘　　要：目的:探讨2种方法治疗剖宫产疤痕部位妊娠(CSP)的预后及治疗方式选择的影响因素。方法:收集176例确诊CSP患者,分为药物+清宫组(药物组,n=68)及介入+药物+清宫组(介入组,n=108),分析清宫时出血量、清宫后h CG下降时间,并电话随访患者清宫后月经来潮时间、月经量变化及再次妊娠情况。结果:介入组在住院时间、清宫时出血量、清宫后h CG下降时间上明显优于药物组,差异有统计学意义(P<0.05)。而在治疗失败率和月经来潮时间上组间均无统计学差异(P>0.05),但月经量变化组间比较差异有统计学意义(P<0.05),介入组月经量减少者多于药物组,而再次妊娠者少于药物组。结论:药物+清宫术治疗与介入+药物+清宫术治疗各有优劣,故在治疗方式上应结合患者实际情况及再生育要求进行慎重选择。在患者h CG水平不高(如<10 000 IU/L)、疤痕较厚(>0.3 cm)时可优先考虑药物+清宫术治疗。Objective： To assess medicine administration and uterine arterial embolization with medicine combined with curettage in treating patients with cesarean scar pregnancy （CSP）. Methods： Pre-, intra- and postoperative conditions of 176 CSP patients were evaluated, of which 68 patients received medicine （methotrexate, mifepristone）＋ uterine curettage under ultrasound monitoring （medicine group）, while 108 patients were treated with uterine arterial embolization with medicine tbllowed by uterine curettage under ultrasound monitoring （intervention group）. The general data, blood loss during curettage, the first menstruation after treatment, the variety of the menstruation and the re-pregnancy outcome of patients were collected and compared. Results： Interven- tion group was superior to medicine group in the hospitalization time, intraoperative blood loss and the recover time of serum [3-hCG after surgery, with significant differences （P〈0.05）. There was no significant difference between the two groups with respect to the laparotomy rate and the menstrual resumption time （P〉0.05）, but the ratio of variation of menstrual volume was significantly different between the two groups （P〈0.05）. In intervention group, cases with menstrual volume decrease were more than medicine group, while cases with subsequent intrauterine pregnancies were less than medicine group （P〈0.05）. Conclusion： Both medicine and uterine arterial embolization combined with curettage have their own merits in treating CSP. Treatment should be individualized and several conditions including demand for re-pregnancy must be considered. Medicine combined with curettage could be the prior choice in case of serum β-hCG under 10 000 IU/L and scar thickness over 0.3 cm.

关 键 词：剖宫产疤痕部位妊娠(CSP) 甲氨蝶呤(MTX) 米非司酮 双侧子宫动脉栓塞术 B超下清宫术 

分 类 号：R714.22[医药卫生—妇产科学]