四种方案治疗子宫切口瘢痕妊娠的疗效比较  

Efficacy Comparison of Four Schemes for Treatment of Cesarean Scar Pregnancy

作　　者：吕燕 韩倩[2] LV Yan;HAN Qian(Department of Obstetrics and Gynecology, Qionglai Hospital of Traditional Chinese Medicine,Qionglai, Sichuan, 611530 China)

机构地区：[1]四川省邛崃市中医医院妇产科,四川邛崃611530 [2]四川省成都市第五人民医院,四川成都611130

出　　处：《医学临床研究》2018年第4期693-695,699,共4页Journal of Clinical Research

摘　　要：【目的】比较四种方案治疗子宫切口瘢痕妊娠（CSP）的疗效。【方法】选取CSP患者130例,按随机数表法分为A组（n=32）、B组（n=30）、C组（n=35）、D组（n=33）。A组采用单纯甲氨蝶呤治疗,B组采用甲氨蝶呤＋清宫术,C组采用子宫动脉栓塞术＋甲氨蝶呤＋清宫术,D组采用宫腔镜手术。比较B、C、D三组手术情况与A、B、C、D四组恢复指标。【结果】A组阴道流血时间、血β-HCG降至正常时间、病灶消失时间分别为（29.55±5.20）d、（44.01±7.23）d、（50.21±6.34）d,明显高于B、C、D组（P〈0.05）;B组术中出血量、住院时间、阴道流血时间、血β-HCG降至正常时间分别为（152.74±58.59）mL、（12.33±3.72）d、（26.18±4.08）d、（31.14±6.14）d明显高于C、D组（P〈0.05）。【结论】四种方案治疗CSP均有疗效,其中子宫动脉栓塞联合方案和宫腔镜手术具有出血量小、病灶清除彻底、术后恢复快等优点,但对设备与技术要求较高,应根据患者具体情况选择合理治疗方案。【Objective】To compare the effects of four schemes for treating cesarean scar pregnancy （CSP） and the time after treatment for human chorionic gonadotropin β （β-HCG） to drop to normal level in each scheme.【Methods】A total of 130 patients with CSP were enrolled in the study. The patients were randomly divided into group A （n=32）, group B （n=30）, group C （n=35） and group D （n=33） by random number table method, according to patient＇s own will. Patients in group A were treated with methotrexate alone, patients in group B were treated with methotrexate combined with uterus curettage, patients in group C were treated with uterine artery embolization combined with methotrexate and uterus curettage, and patients in group D were treated with hysteroscopic operation. The state of operation was compared among group B, group C and group D. The recovery indexes were compared among the four groups.【Results】The vaginal bleeding time, blood β-HCG dropping to normal time, and the time of lesion disappearing in group A were [ （29.55±5.20） d, （44.01±7.23） d, （50.21±6.34） d], respectively, which were significantly longer than those in group B, group C or group D （P〈0.05）. The intraoperative blood loss, length of hospitalization, vaginal bleeding time and time for blood β-HCG to drop to normal in group B were [ （152.74±58.59） ml, （12.33±3.72） d, （26.18±4.08） d, （31.14±6.14） d], respectively, which were significantly more or longer than those in group C or group D （P〈0.05）.【Conclusion】All four schemes are effective in the treatment of CSP. Uterine artery embolization combined with hysteroscopic surgery has advantages of a small amount of bleeding, complete debridement and quick recovery, however, it requires equipment and techniques. The most reasonable treatment plan should be chosen according to the actual condition of patients.

关 键 词：子宫 瘢痕 甲氨蝶呤/治疗应用 刮宫术 栓塞 治疗性 子宫/血液供给 宫腔镜检查 

分 类 号：R714.2[医药卫生—妇产科学]