【作者】 余静；

【导师】 汪利群；

【作者基本信息】 南昌大学 ， 妇产科学， 2012， 硕士

【摘要】 目的：研究子宫切口妊娠的发病趋势、临床表现、治疗及预后，探讨各种保留生育功能的疗法在切口妊娠治疗中的价值及意义。方法：1、分析我院2007年1月-2011年12月243例切口妊娠患者的临床资料。研究其发病特点及趋势。2、对首诊误诊组（研究组）及首诊确诊组（对照组）两组病例的临床资料、治疗及预后进行分析。3、随机抽取甲氨喋呤（MTX）全身用药+清宫术治疗组34例，子宫动脉栓塞+清宫术治疗组46例，子宫动脉栓塞+手术病灶清除治疗组20例，研究三种保留生育功能的治疗方法在切口妊娠治疗中的价值及意义。结果：1、切口妊娠的发病率呈逐年上升趋势，首诊误诊率高达53.5%。2、误诊组入院时停经天数、入院时血HCG值两个指标与确诊组比较，差异有统计学意义（P<0.05）。两组间贫血病例数及治疗中需输血病例数相比较，差异有统计学意义（P <0.05）。但两组间预后经比较，P>0.05，差异无统计学意义。3、三组的治疗成功率分别为：MTX全身用药+清宫术治疗组67.6%，子宫动脉栓塞+清宫术治疗组91.3%，子宫动脉栓塞+手术病灶清除治疗组95.0%。P<0.05，差异有统计学意义。三组间住院天数及住院费用经比较，差异有统计学意义（P <0.05）。结论：1、切口妊娠的发病率呈逐年上升趋势，极易误诊。2、切口妊娠误诊后行人工流产、药物流产及清宫术是造成切口妊娠出血及贫血的重要原因之一。3、切口妊娠的治疗应首选保留生育功能的治疗方法。MTX全身用药+清宫术、子宫动脉栓塞+清宫术和子宫动脉栓塞+病灶清除术3种治疗方案如应用恰当均取得较好效果。应根据患者的具体情况，选择合理的治疗方式。更多还原

【Abstract】 Objective：To study the Incidence trends of cesarean scar pregnancy(CSP), clinicalmanifestations, treatment and prognosis, to explore the value and significance ofvarious preserve fertility therapy in the treatment of incision pregnancy.Methods：1.Analysis of clinical data of our hospital from January2007to2011Decemberof cesarean scar pregnancy. Study the incidence of characteristics and trends.2.Comparison misdiagnosis group (study group) and the initial diagnosisconfirmed group (control group) the clinical data of the two groups of patients,analysis of its treatment and prognosis.3.Random sample of methotrexate (MTX) systemic administration+curettagetreatment group (34cases), Uterine artery embolization+curettage treatment group(46cases), Uterine artery embolization+laparotomy pregnancy debridement treatmentgroup (20cases).To study the value and significance of three to preserve fertilitytreatment in the incision pregnancy treatment.Results:1. The incidence of incision pregnancy increasing year by year, the misdiagnosisrate is as high as53.5%.2. Comparison misdiagnosed group and diagnosis group two indicators ofMenopause days and serum HCG values, the difference was statistically significant(P <0.05). The comparison the number of cases of anemia and blood transfusioncases between the two groups, the difference was statistically significant (P <0.05).However, the prognosis between the two groups by comparison, P>0.05, thedifference was not statistically significant.3. Three groups of treatment success rates were: methotrexate (MTX) systemicadministration+curettage treatment group was67.6%, Uterine artery embolization+curettage treatment group was91.3%, uterine artery embolization+laparotomypregnancy debridement treatment group was95.0%. P <0.05, the difference was statistically significant. Hospital stay and hospitalization costs in the three groupswere compared, the difference was statistically significant (P <0.05).Conclusion1. Cesarean scar pregnancy incidence rate showed an increasing trend, easilymisdiagnosed.2.Cesarean scar pregnancy misdiagnosed underwent abortion, medical abortionand curettage is one of the important reasons to cause CSP bleeding and anemia.3.The CSP treatment should be preferred to preserve fertility treatment. Threekinds of treatment programs of methotrexate (MTX) systemic administration+curettage, Uterine artery embolization+curettage, uterine artery embolization+laparotomy pregnancy debridement, such as used properly can achieve good results.Should be based on the patient’s specific circumstances, Select a reasonabletreatment.更多还原