【摘要】 目的:探讨甲氨喋呤(MTX)+米非司酮+超声引导下清宫术、子宫动脉栓塞术+超声引导下清宫术和孕囊穿刺抽吸术治疗剖宫产后瘢痕妊娠的临床价值。方法:回顾性分析2008年10月至2015年1月广西桂平市人民医院共收治92例剖宫产后瘢痕妊娠(CSP)患者,所有患者经临床及超声检查确诊为CSP,分别使用甲氨喋呤(MTX)+米非司酮+超声引导下清宫术、子宫动脉栓塞术+超声引导下清宫术和孕囊穿刺抽吸术治疗。结果:治疗后,甲氨喋呤(MTX)+米非司酮+超声引导下清宫术组HCG下降理想,但是下降程度不及子宫动脉栓塞术+超声引导下清宫术组和;阴道或经腹部穿刺孕囊抽吸组,住院费用甲氨喋呤(MTX)+米非司酮+超声引导下清宫术组最低,出血量阴道或经腹部穿刺孕囊抽吸组组最低(P<0.05)。结论:每个CSP患者应制定个体化的治疗方案。甲氨喋呤(MTX)+米非司酮+超声引导下清宫术疗效不确切,且具有较高风险,子宫动脉栓塞术+超声引导下清宫术和孕囊穿刺抽吸术作为有效、安全的两种方法,值得推广。更多还原

【Abstract】 Objective:To discuss the clinical value of methotrexate(MTX)+mifepristone+ultrasound guided curettage, uterine artery embolization+ultrasound guided curettage and gestational sac puncture and suction in respect of treatment of cesarean scar pregnancy(CSP).Methods:Ninety-two cases of cesarean scar pregnancy diagnosed by clinical and ultrasonic approaches and treated respectively with MTX+mifepristone+ultrasound guided curettage, uterine artery embolization+ultrasound guided curettage and gestational sac puncture and suction in our hospital during October 2008 and January 2015 were subject to a retrospective analysis.Results:After treatment, HCG decreased ideal in methotrexate(MTX)+mifepristone plus ultrasound guided curettage group,but decreased less uterine artery embolization combined with ultrasound guided under curettage group and vaginal or abdominal puncture gestational sac aspiration group;Hospital cost in methotrexate(MTX)+and our ketone+ultrasound guided curettage group was the lowest,bleeding amount of vaginal or by abdominal puncture gestational sac suction group had the lowest(P<0.05).Conclusion:Individual therapeutic regimens should be established for all CSP cases.MTX+mifepristone+ultrasound guided curettage has uncertain effects with a relatively high risk, uterine artery embolization +ultrasound guided curettage and gestational sac puncture and suction are two effective and safe methods and worth promoting.更多还原