剖宫产瘢痕妊娠患者不同治疗方案的疗效比较  

Comparison of curative effects of different methods for treating cesarean scar pregnancy

作　　者：刘盼 刘洪梅[1] LIU Pan;LIU Hongmei(Department of Obstetrics and Gynecology,Anhui Maternal and Child Health Hospital,Hefei 230000,China)

机构地区：[1]安徽医科大学附属妇幼保健院,合肥230000

出　　处：《安徽医学》2018年第11期1318-1322,共5页Anhui Medical Journal

基　　金：2015年度合肥市科技攻关计划项目(项目编号:2015-59)

摘　　要：目的分析剖宫产瘢痕妊娠不同治疗方案的临床疗效。方法回顾性分析2015年1月至2017年12月安徽省妇幼保健院收治的183例剖宫产瘢痕妊娠患者的临床资料,根据治疗方案不同分成4组:A组44例,采用清宫术; B组32例,采用甲氨蝶呤+子宫动脉栓塞术+清宫术; C组11例,采用甲氨蝶呤+子宫动脉栓塞术+子宫瘢痕妊娠物切除加修补术; D组96例,采用阴式子宫瘢痕妊娠物切除加修补术,观察并比较4组患者围术期相关指标[术中出血量、术后第2天血β-人绒毛膜促性腺激素(β-HCG)下降率、住院天数]、住院费用、术后并发症、治疗成功率及预后随访指标(血β-HCG恢复正常的时间、月经复潮时间、术后妊娠例数等)。结果 4组患者术中出血量及术后妊娠例数比较,差异均无统计学意义(P> 0. 05)。C组术后第2天血β-HCG下降率及血β-HCG恢复正常的时间均优于其他3组,但住院天数、住院费用高于其他3组,差异均有统计学意义(P <0. 05)。A、B、C、D组患者治疗成功率分别为81. 82%、100%、100%、94. 79%,差异有统计学意义(P <0. 05)。B组月经复潮时间大于其他3组,差异有统计学意义(P <0. 05)。结论甲氨蝶呤+子宫动脉栓塞术+子宫瘢痕妊娠物切除加修补术的临床疗效较好,但其住院时间长、住院费用较高。Objective To analyze the clinical effects of different treatment options for cesarean scar pregnancy. Methods The clinical data of 183 patients with cesarean scar pregnancy who were admitted to Anhui Maternal and ChildHealth Hospital between January 2015 and December 2017 were retrospectivelyanalyzed. These patients were divided into 4 groups according to the treatmentmethods, group A （ n =44） were treated with curettage; Group B （ n =32） were treated with methotrexate plusing uterine artery embolization and curettage; Group C （ n =11） were treated with methotrexate plusing uterine artery embolizationand uterine scar pregnancy excision plusing repair; Group D （ n =96） were treatedwith transvaginal uterine scar pregnancy resection and repair. Observed and compared the perioperative related indexes of 4 groups of patients [intraoperative blood loss, blood β-human chorionic gonadotropin （β-HCG） decline rate, length of hospital stay], hospitalization expenses, postoperative complications , treatment success rate and prognosis follow-up indicators （blood β-HCG returns to normal time, menstrual re-tidal time, postoperative pregnancy, etc.）. Results There was no significant difference in intraoperative blood loss and postoperative pregnancy between the 4 groups （P 〉0.05）. The decline rate of blood β-HCG on the second postoperative day and the time of blood β-HCG recovery to normal in group C patients were better than those in the other 3 groups. However, the hospitalization days and expenses were higher than the other 3 groups, the differences between the 4 groups were statistically significant （ P 〈0.05）. The success rates of treatment in group A, B, C, and D were 81.82%, 100%, 100%, and 94.79%, respectively, and the difference was statistically significant （ P 〈0.05）. The menstrual recovery time in group B was larger than that in the other three groups, and the difference was statistically significant （ P 〈0.05）. Conclusion The better effect was obtained with me

关 键 词：剖宫产瘢痕妊娠 清宫术 子宫动脉栓塞术 经阴道瘢痕妊娠物切除术 

分 类 号：R714.22[医药卫生—妇产科学]