剖宫产瘢痕部位妊娠的超声分型与治疗方案选择的比较  

Compare Different Treatment Method for Different Classification of Caesarean Scar Pregnancy by Ultrasound

作　　者：蒋瑜[1] 杨太珠[1] 罗红[1] 谢川[2] 

机构地区：[1]四川大学华西第二医院超声科,成都市610041 [2]四川大学华西第二医院妇科,成都市610041

出　　处：《中国超声医学杂志》2016年第7期635-638,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨剖宫产瘢痕部位妊娠的超声分型以及不同治疗方案的临床结局。方法根据声像图特征,将纳入的瘢痕妊娠分为孕囊富血流型、孕囊乏血流型、包块富血流型和包块乏血流型。每种类型的瘢痕妊娠患者分别接受不同治疗方案。方案A:子宫动脉栓塞术联合甲氨蝶呤治疗;方案B:超声引导下行刮宫术;方案C:甲氨蝶呤全身疗法(肌内注射)。观察治疗成功率、β-HCG恢复至正常的时间、阴道流血量及住院时间。治疗成功指无并发症的发生以及无子宫切除。卡方检验比较同种类型三种治疗方案的治疗成功率是否有显著性差异。方差分析比较同种类型三种治疗方案之间的阴道流血量、β-HCG恢复至正常的时间以及住院时间。结果随访的462例瘢痕部位妊娠,138例孕囊富血流型及142例包块富血流型:方案A的治疗成功率明显高于方案B和方案C,阴道流血量、β-HCG恢复至正常的时间以及住院时间均小于方案B和方案C(P<0.05)。109例包块乏血流型及73例孕囊乏血流型:三种方案的治疗疗效无显著性差异(P>0.05)。结论子宫动脉栓塞术联合甲氨蝶呤治疗富血流型瘢痕部位妊娠疗效较好。Objective To discuss the classification in caesarean scar pregnancy（CSP）by ultrasound and compare the clinical outcome of different treatments.Methods According to the blood flow in sonographic,CSP could be divided into four types：type I as gestational sac with rich blood flow,typeⅡ as gestational sac with few blood flow,typeⅢ as mass with rich blood flow and typeⅣ as mass with few blood flow.Each type of CSP was distrusted randomly into three groups,accepting different treatments.Group A：uterine artery embolization（UAE）and local methotrexate（MTX）,group B：Dilation Curettage（DC）,group C：system MTX.Outcome：the rate of treatment success;time ofβhuman chorionic gonadotrophin（β-HCG）recovering to normal value;volume of vaginal bleeding and time in hospital.Treatment successful was defined as patients without complications and hysterectomy.The compare in three treatments in the same type was made by Chi-square test.The compare in three groups in the time from abnormal to normal ofβ-HCG;volume of vaginal bleeding and time in hospital were made by analysis of variance.Results In 462 patients with 138 cases as type I and 142 cases as typeⅢ：success rate of group A was obviously higher than that of group B and group C.The volume of vaginal bleeding,the time ofβ-HCG recovering to normal and time in hospital of group A were less than those of group B and group C（P〈0.05）.109 cases as typeⅡ and 73 cases as typeⅣ：there were no significant differences in success rate,volume of vaginal bleeding and time ofβ-HCG recovering to normal among the three groups（P〈0.05）.Conclusions UAE and local MTX could effectively treat for CSP with rich blood flow.

关 键 词：剖宫产瘢痕部位妊娠 超声 子宫动脉栓塞术 刮宫术 甲氨蝶呤 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.22[医药卫生—诊断学]