剖宫产瘢痕妊娠不同临床分型治疗方式的探讨  

THE STUDY OF TREATMENT METHODS FOR DIFFERENT CLINICAL TYPES OF CAESAREAN SCAR PREGNANCY

作　　者：霍艳[1] 段海风[1] 韩敏[1] 李颖姗 徐丽华 马海英[1] Huo Yan Duan Haifeng Han Min et al(Handan First Hospital, Handan 056002, Chin)

机构地区：[1]河北省邯郸市第一医院,056002

出　　处：《中国煤炭工业医学杂志》2017年第9期1027-1030,共4页Chinese Journal of Coal Industry Medicine

基　　金：河北省卫计委课题(编号:20150442)

摘　　要：目的探讨剖宫产瘢痕妊娠(CSP)不同临床分型应用三种方法治疗的有效性和安全性。方法回顾性分析2008年1月—2016年6月该院收治的剖宫产瘢痕妊娠52例,根据治疗方法分成三组,吸宫术组、剖宫产瘢痕妊娠病灶切除术组和甲氨蝶呤(MTX)药物治疗组,总结三组中CSP的不同分型以及CSP不同临床分型治疗效果和愈后。结果吸宫术组29例手术均成功,CSP临床分型Ⅰ型27例,Ⅱ型2例,平均住院日4d,平均出血量50ml,平均术后出血时间15d,平均术后β-HCG恢复正常时间20d,局部包块吸收时间1~3个月。剖宫产瘢痕妊娠病灶切除术组9例均成功,CSP临床分型均为Ⅲ型,平均住院日7d,平均出血量100ml。术后无淋漓出血。MTX药物治疗组14例,4例Ⅰ型瘢痕妊娠,用MTX后复查β-HCG升高改行吸宫术,1例Ⅲ型瘢痕妊娠用MTX后阴道大量出血改行瘢痕妊娠病灶切除术,6例Ⅱ型瘢痕妊娠β-HCG下降后行宫腔镜下病灶切除术,另3例Ⅱ型瘢痕妊娠β-HCG下降后胎囊自行排出。平均住院天数12d。结论临床治疗中应该根据CSP不同的临床分型采取适宜治疗方式。对于Ⅰ型CSP直接清宫术是最经济的治疗方法,Ⅲ型CSP妊娠病灶切除术是最安全的治疗方法,种植深度介于二者之间的Ⅱ型CSP适宜采取MTX药物治疗。Objective To explore the effectiveness and safety of treatment methods for different clinical types of caesarean scar pregnancy（CSP）.Methods The clinical data of 52 cases of CSP from 2008 to 2016 were retrospective analyzed.According to the different types of treatment method,the therapy effects and recovery conditions in the different clinical types of CSP were compared.Results Curettage was in29 cases,including 27 cases CSP clinical classification as type Ⅰ,2 cases in type Ⅱ.The treatment of this group patients was succeed whose average blood loss was 50 ml,average hospitalization time was 4d,time of blood loss after operation was 15 d,blood HCG returned to normal was 2-4 weeks,the time of local hematoma absorption was 1-3 months.Cesarean scar pregnancy debridement and uterine repair surgery in 9 cases was succeed in all patients which were all type Ⅲ,average hospitalization time was 7d,average blood loss was 100 ml,no vaginal bleeding complications occurred.The MTX group had 14 cases,including 4 cases of type Ⅰ which operated curettage because of β-HCG increased,1 case of type Ⅲ which operated cesarean scar pregnancy debridement and uterine repair surgery because of lots of vaginal bleeding after MTX treatment,6 cases of type Ⅱ which was performed removal of lesion under hysteroscopy,and the other 3 cases of type Ⅱ whose fetal sac discharged afterβ-HCG decreased.Average hospitalization time was 12 d for all patients.Conclusion Appropriate treatment should be adopted according to different clinical types of CSP.Curettage is the most economical method of treatment for Type Ⅰ,Excision of lesion of scar pregnancy is the best safety treatment for type Ⅲ,MTX drug therapy is suitable for typeⅡ which planting depth between Type Ⅰ and Type Ⅲ.

关 键 词：剖宫产瘢痕妊娠 临床分型 治疗方式 

分 类 号：R719.8[医药卫生—妇产科学]