【摘要】 目的探讨剖宫产后子宫瘢痕妊娠(CSP)的改良分型对其治疗的指导意义。方法我院2010年7月至2013年1月收治39例CSP患者,根据子宫瘢痕妊娠的改良分型选择治疗方法,Ⅰ型采用药物治疗加清宫手术或宫腔镜手术;Ⅱa型采用药物治疗、宫腔镜手术、腹腔镜手术或宫腹腔镜联合手术;Ⅱb型采用经腹或腹腔镜下子宫修补术,不采用或不单独采用宫腔镜手术。结果 3种分型治疗的术中出血量两两比较差异有统计学意义(P<0.05),而住院时间和血β-h CG水平恢复时间3种分型治疗的差异均无统计学意义(P>0.05)。除1例单纯药物治疗外,其余病例均由术中确诊,输血治疗1例。曾表现为院内外人流术中大出血者Ⅰ型2例,Ⅱa型1例,Ⅱb型4例。各型均无子宫切除病例。结论根据子宫瘢痕妊娠的改良分型选择治疗方法,针对性强,效果可靠,预后良好。更多还原

【Abstract】 Objective To investigate the treatment guiding significance of a modified classification of caesarean section scar pregnancy(CSP).Methods Clinical data of 39 CSP cases were analyzed retrospectively.The patients were admitted to our hospital during the period from July 2010 to January 2013.They were treated with different therapeutic regimens according to the CSP modified classification.The patients with type ⅠCSP were treated with medication and dilation and curettage or hysteroscopy.The patients with type Ⅱa were treated with medication,hysteroscopy,laparoscopy or laparoscopy combined with hysteroscopy.The patients with type Ⅱb were treated with transabdominal or laparoscopic uterine repair but not hysteroscopy.Results There were significant differences in intraoperative blood loss among the 3 groups.The difference of average hospital day and average recovery time of serum β-h CG was not significantly different.Except one case with simple medication,the diagnosis was all confirmed by surgery.One patient received the blood infusion.There were 2 cases in the type Ⅰ group,1 case in the Ⅱa group and 4 cases in the Ⅱb group showed a heavy vaginal bleeding during dilation and curettage.All patients were cured successfully without any hysterectomy.Conclusion The modified classification of CSP plays a directive role in guiding treatment options.The effect is reliable and the prognosis may be fairly good.更多还原