不同治疗方法对剖宫产瘢痕部位妊娠的临床效果分析及安全性评估  

Clinical effect analysis and security assessment of different treatment methods for cesarean section scar pregnancy

作　　者：石婧 陈金娇 吴湘光 林晓婷 周惠玲[1] 王薇[1] 范良生[1] SHI Jing;CHEN Jin-Jiao;WU Xiang-Guang(Department of Obstetrics and Gynecology,the First Afiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510030,China)

机构地区：[1]广州医科大学附属第一医院妇产科,广东广州510030

出　　处：《中国妇幼保健》2022年第17期3127-3130,共4页Maternal and Child Health Care of China

基　　金：国家自然科学基金项目(81971341,81302249);广东省医学科研基金(A2015451)。

摘　　要：目的探讨3种不同治疗方法对Ⅰ型、Ⅱ型剖宫产术后瘢痕部位妊娠的临床效果及安全性。方法选取2010年1月—2020年4月广州医科大学附属第一医院的96例剖宫产瘢痕部位妊娠患者的临床资料进行回顾性分析,根据不同治疗方法分为3组,A组22例B超引导下清宫术;B组22例双侧子宫动脉栓塞术且术后24~48 h内行清宫术;C组52例甲氨蝶呤+子宫动脉灌注化疗栓塞术且术后24~48 h内行清宫术。比较3组间术后24 hβ-人绒毛膜促性腺激素(β-hCG)下降水平、出血量、住院时间、住院费用情况。结果A组、B组和C组的术后24 hβ-hCG下降水平差异有统计学意义(P<0.05);A组、B组和C组的术中出血量差异无统计学意义(P>0.05)。A组、B组和C组的住院时间差异无统计学意义(P>0.05)。A组住院费用少于B组和C组,差异有显著统计学意义(P<0.01);B组住院费用多于C组,但差异无统计学意义(P>0.05)。结论治疗Ⅰ、Ⅱ型子宫瘢痕部位妊娠的患者优先选择B超引导下清宫术,可兼顾疗效、出血少、费用低、损伤小等优点,具有临床使用价值。Objective To explore the clinical effect and security of three treatment methods for typeⅠand typeⅡcesarean section scar pregnancy.Methods From January 2010 to April 2020,the clinical data of 96 patients with cesarean section scar pregnancy from the First Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed.All the patients were divided into three groups according to different treatment methods:group A(22 patients treated with B-ultrasound-guided uterine curettage),group B(22 patients treated with bilateral uterine arterial embolization,followed by uterine curettage within 24-48 hours after delivery),group C(52 patients treated with methotrexate+uterine arterial infusion chemoembolization,followed by uterine curettage within 24-48 hours after delivery).The decline ofβ-human chorionic gonadotrpin(β-hCG)level at 24 hours after delivery,the amount of intraoperative blood loss,the length of hospital stay,and hospitalization expense were compared among the three groups.Results There was statistically significant difference in the decline ofβ-hCG levels at 24 hours after delivery among the three groups(P<0.05),there was no statistically significant difference in the amount of intraoperative blood loss among the three groups(P>0.05).There was no statistically significant difference in the length of hospital stay among the three groups(P>0.05).The hospitalization expense in group A was statistically significantly less than those in group B and group C(P<0.01).The hospitalization expense in group B was higher than that in group C,but there was no statistically significant difference(P>0.05).Conclusion B-ultrasound-guided uterine curettage is recommended for patients with typeⅠand typeⅡcesarean section scar pregnancy,which has the advantages of high clinical efficacy,mild blood loss,low cost,and slight trauma,the method has clinical use value.

关 键 词：剖宫产瘢痕部位妊娠 甲氨蝶呤 子宫动脉栓塞 清宫术 

分 类 号：R714.2[医药卫生—妇产科学]