【摘要】 目的探讨不同治疗方案在子宫下段剖宫产后切口瘢痕处妊娠(cesarean scar pregnancy,CSP)的价值。方法回顾性分析2011年2月至2015年6月南京医科大学附属南京市妇幼保健院收治的109例CSP患者的临床资料,按治疗方案不同分为A、B、C 3组。A组采用子宫动脉甲氨蝶呤(Methotrexate,MTX)灌注+子宫动脉栓塞(uterine artery embolization,UAE)治疗(22例);B组采用子宫动脉MTX灌注+UAE联合清宫术(62例);C组采用米非司酮配伍米索前列醇药物流产联合清宫术(25例)。比较3组患者治疗情况。结果 B组患者治疗前后血清β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)下降率(84.63%)和成功率(98.39%)最高,与A组(55.02%、94.45%)、C组(57.91%、80.00%)比较,差异有统计学意义(P<0.05);B组刮宫术中出血量(27.74 m L)低于C组(110.40 m L)(P<0.05);但B组的住院费用和住院时间(11 901.37元、10.18 d)均高于C组(4 545.81元、5.32 d)(P<0.05)。介入术后7 d内刮宫术中出血量(16.46 m L)少于7 d后刮宫术中出血量(49.76m L)(P<0.05)。结论经子宫动脉化疗栓塞后7 d内联合清宫术治疗瘢痕妊娠治疗成功率最高,综合效果最佳。更多还原

【Abstract】 Objective To investigate the value of different treatments on cesarean scar pregnancy( CSP) in the lower uterine segment. Methods The clinical data of 109 cases of CSP patients treated in Nanjing Maternal and Child Health Hospital affiliated of Nanjing Medical University from Feb. 2011 to June 2015 was retrospectively analyzed. According to the treatment program,the patients were divided into three groups: methotrexate( MTX) plus uterine artery embolization( UAE) group( group A,n = 22); methotrexate plus UAE and uterine curettage group( group B,n = 62); mifepristone combined misoprostol and uterine curettage group( group C,n= 25). Compared therapeutic effect of three groups. Results The descent rate of the serum β- HCG and success rate( 84. 63 % 、98. 39 %) in group B were higher than those of group A( 55. 02 % 、94. 45 %) and group C( 57. 91 % 、80. 00 %),the differences were statistically significant( P < 0. 05); The blood loss of group B during curettage( 27. 74 m L) was lower than that of group C( 110. 40 m L),the difference was statistically significant( P < 0. 05); The hospital costs and hospital spans of group B( $ 11 901. 37、10. 18 d)were more than those of group C( $ 4 545. 81、5. 32 d),the differences were statistically significant( P < 0. 05). The curettage blood loss of intervention combined with curettage within seven days( 16. 46 m L) was lower than that after seven days( 49. 76 m L),the difference was statistically significant( P < 0. 05). Conclusion The treatment success rate of UAE therapy combined with curettage within seven days is the highest,the combined effect is the best.更多还原