| 李 杰,高建华,郑建华,宋倩琳,牛 荔.剖宫产瘢痕妊娠60例的临床治疗体会[J].,2017,17(20):3871-3875 |
| 剖宫产瘢痕妊娠60例的临床治疗体会 |
| Cesarean Scar Pregnancies: Experience of 60 Cases |
| 投稿时间：2016-11-26 修订日期：2016-12-20 |
| DOI：10.13241/j.cnki.pmb.2017.20.016 |
| 中文关键词: 剖宫产瘢痕妊娠 内生型 外生型 |
| 英文关键词: Cesarean scar pregnancy Endogenous type Exogenous type |
| 基金项目:黑龙江省自然科学基金项目（QC2009C28） |
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| 中文摘要: |
| 摘要 目的：探讨不同类型剖宫产瘢痕妊娠(CSP)的治疗方法。方法：选择经临床确诊为CSP的患者60例，根据CSP的类型分为内生型组(I组)19例和外生型组(Ⅱ组)41例，每组再根据不同治疗方法各分为两个亚组，I组包括：IA组应用甲氨喋呤( MTX，Methotrexate)后超声引导下清宫术(7例)；IB组应用MTX及双侧子宫动脉灌注化疗栓塞术(UACE，Uterine aytery embolization chemotherapy)后超声引导下清宫术(12例)。Ⅱ组包括：ⅡA组行超声引导下清宫术+/-MTX(11例)；ⅡB组应用MTX+UACE+超声引导下清宫术(30例)。以妊囊大小、术中出血量、人绒毛膜促性腺激素(β-human chorionic gonadotropin，β-HCG )恢复正常时间、首次治愈率、二次治愈率、住院时间、住院费用及月经恢复正常时间、术后妊娠率作为疗效评估参数比较两组中亚组间相关数据的差异。结果：I组中，两亚组妊囊大小、术中出血量、住院天数、血HCG及月经恢复时间、首次治愈率比较差异无统计学意义(P>0.05)；IA组住院花费明显少于IB组(P<0.05)。Ⅱ组中，两亚组住院天数、住院费用及妊囊大小比较差异无统计学意义(P>0.05)；ⅡA组术中出血量及月经恢复时间明显多于ⅡB组，血HCG下降率及首次治愈率明显低于ⅡB组(P<0.05)。结论：CSP可根据类型选用合适的治疗方法。内生型适用于MTX+超声引导下清宫术，而外生型适用于MTX+UACE+超声引导下清宫术。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the treatment of different types of cesarean scar pregnancy. Methods: According to the type of CSP, a total of 60 patients with clinically confirmed cesarean scar pregnancy were divided into two groups: group I (endogenous type group, n=19) and group Ⅱ(exogenous type group, n=41). Patients in each group were subdivided into subgroups. Group I: IA subgroup set of Ultrasound-guided dilation and curettage(D＆C) after using MTX(7 cases); IB subgroup set of Ultrasound-guided D＆C after using MTX as well as UACE(12 cases). Group Ⅱ: ⅡA subgroup set of Ultrasound-guided dilation and curettage with or without MTX; ⅡB subgroup set of Ultrasound-guided D＆C after using MTX as well as UACE. The amount of blood loss during curettage, the recovered time of human chorionic gonadotropin (HCG) level, hospital stay, gestational sac diameter, the twice treatment rate, hospitalization expence, time for menstruation normalization, pregnancy rates after operation and the success rate of the first treatment were measured and were used as the therapeutic evaluation parameters. The results were compared between the subgroups. Results: Group I: No significant difference was found in the gestational sac diameter, blood loss during curettage, the recovered time of human chorionic gonadotropin (HCG) level, time for menstruation normalization, hospital stay and the success rate of the first treatment; the hospitalization expence in IA subgroup was significantly less than that in IB. Group Ⅱ: No significant difference was found in hospital stay,hospitalization expence and Gestational sac diameter, while the blood loss during curettage in ⅡA Subgroup was more than in ⅡB subgroup, the scale of decrease of serum hcg and success rate of the first treatment in subgroup ⅡA were lower than the ⅡB subgroup, and the time for menstruation normalization in IA subgroup was longer than that of ⅡB subgroup(P <0.05). Conclusion: Appropriate treatment should be selected for different types of CSP. For the treatment of endogenous type of CSP, it was better to use Ultrasound-guided D＆C after MTX, while Ultrasound-guided D＆C after MTX and UACE was applied to the treatment of exogenous type of CSP. |
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