基于超声分型治疗剖宫产瘢痕妊娠的效果及再妊娠结局  

Effect and re-pregnancy outcomes of the treatment based on ultrasonic classification for caesarean scar pregnancy

作　　者：王建爽 张海静 王雪松 文颖 周子敬 wANG Jianshuang;ZHANG Haijing;WANG Xuesong;WEN Ying;ZHOU Zijing(Department of Ultrasound Diagnosis,Fourth People's Hospital of Langfang City,of filiated Hospital of Chengde Medical College,Hebei Lang fang 065700,China;Department of Obstetrics and Gynecology,Fourth People's Hospital of Langfang City,of filiated Hospital of Chengde Medical College,Hebei Lang fang 065700,China)

机构地区：[1]廊坊市第四人民医院承德医学院附属医院超声诊断科,河北廊坊065700 [2]廊坊市第四人民医院承德医学院附属医院妇产科,河北廊坊065700

出　　处：《中国妇幼健康研究》2021年第7期1068-1072,共5页Chinese Journal of Woman and Child Health Research

基　　金：廊坊市科学技术研究与发展计划资助项目(2019013101)。

摘　　要：目的探讨基于超声分型治疗剖宫产瘢痕妊娠(CSP)的临床效果及再次妊娠结局。方法回顾性分析2015年1月至2017年6月廊坊市第四人民医院收治的CSP患者105例,根据超声检查结果和分型标准,分为Ⅰ型(A组)46例和Ⅱ型(B组)59例。A组采用米非司酮口服+超声监视下清宫术治疗;B组采用子宫动脉甲氨蝶呤(MTX)灌注+明胶海绵颗粒栓塞+超声监视下清宫术或病灶切除术治疗。收集两组患者术前的一般临床资料,比较两组治疗方案的手术时间、术中出血量、β-人绒毛膜促性腺激素(hCG)恢复至正常时间、月经恢复时间、住院天数、住院费用、治疗成功率及再次妊娠结局情况。结果两组的人工流产次数、妊娠囊最大径线、妊娠囊处肌层厚度及妊娠囊周围血供丰富比例差异均有统计学意义(t/χ^(2)值分别为7.615、5.358、9.694、4.459,P<0.05)。B组的手术时间、住院天数、住院费用均显著高于A组(t值分别为10.453、8.213、13.841,P<0.05)。两组治疗成功率均为100%,无子宫切除病例。清宫术5天后,两组β-hCG血清水平均显著下降,超声复查显示病灶已清除。3年随访显示,两组的自然妊娠率、CSP复发率、妊娠晚期分娩率差异均无统计学意义(P>0.05)。结论基于超声分型选择CSP治疗方案,针对性强,成功率高,有一定的临床应用价值。Objective To investigate the clinical effect and re-pregnancy outcomes of the treatment based on ultrasonic classification for caesarean scar pregnancy(CSP).Methods The clinical data of 105 patients with CSP,who were admitted to the Fourth People′s Hospital of Langfang from January 2015 to June 2017,was retrospectively analyzed.According to the results of ultrasound examination and classification standards,all patients were divided into typeⅠwith 46 cases(group A)and typeⅡwith 59 cases(group B).Group A was treated with mifepristone oral administration,dilatation and curettage monitored by ultrasound.Group B was treated with uterine arterial methotrexate(MTX)perfusion,gelatin sponge particle embolic agent,and dilatation and curettage monitored by ultrasound or focal resection.The general clinical information before operation of two groups was collected.Operative time,intraoperative blood loss,β-human chorionic gonadotropin(hCG)recovery time,menstrual recovery time,length of stay in hospital,hospitalization cost,treatment success rate and re-pregnancy outcomes were compared between two groups.Results The differences between two groups in number of abortions,maximum diameter of gestational sac,thickness of muscular layer at gestational sac,and proportion of abundant blood supply around gestational sac were statistically significant(t/χ^(2)=7.615,5.358,9.694,and 4.459,respectively,P<0.05).The operative time,length of stay in hospital,and hospitalization cost of group B were significantly higher than those of group A(t=10.453,8.213,and 13.841,respectively,P<0.05).The treatment success rates in two groups both were 100%,and there was no case of hysterectomy.Serum levels ofβ-hCG in two groups both decreased significantly at 5 d after dilatation and curettage,and the ultrasonography examination review showed that lesions had been cleared.The results of 3-year follow-up showed that there was no statistically significant difference between two groups in spontaneous pregnancy rate,CSP recurrence rate and delivery r

关 键 词：剖宫产瘢痕妊娠 超声分型 再次妊娠 子宫动脉栓塞 药物治疗 

分 类 号：R714.22[医药卫生—妇产科学] R445.1[医药卫生—临床医学]