现代妇产科进展2016，Vol.25Issue(8)：603-607,5.DOI:10.13283/j.cnki.xdfckjz.2016.08.012
224例剖宫产术后子宫疤痕妊娠不同治疗方法的临床疗效分析
Efficacy of different treatment of 224 cases of cesarean scar pregnancy
摘要
Abstract
Objective:To investigate the efficiency of different methods in treating pa-tients with cesarean scar pregnancy ( CSP) . Methods:224 CSP patients who received different treatments in Fujian Maternity and Children Health Hospital were retrospectively analyzed. Pa-tients were divided into 4 groups according to method of the treatment:drug therapy followed by dilatation and curettage(Group A);uterine artery embolization (UAE) followed by dilatation and curettage( Group B);CSP abdominal lesion resection combined with repair( Group C);CSP laparoscopic lesion resection combined with repair ( Group D ) . According to different medica-tion,group A was further divided into 4 subgroup:methotrexate ( MTX) ( local/systemic) for treatment(A1),trichosanthin for treatment(A2),methotrexate (MTX) (local/systemic) com-bined with trichosanthin for treatment(A3),mifepristone for treatment (A4). Similarly,goup C was further divided into 2 subgroups:lesion section with UAE preoperatively ( C1 );lesion sec-tion without UAE preoperatively(C2). Results:The rates of therapeutic success in group A、B、C、D were 90. 12%、95. 61%、100%、100% respectively,the difference was not statistically sig-nificant(P=0. 255),although the serum β-HCG level at the hospitalized time,type of CSP, hemorrhage,operative duration,hospital stays,and therapeutic cost,showed statistically signifi-cant difference(P<0. 05 for all),among Group A,B,C and D. Within Group A,there was no statistically significant difference of therapeutic success rate ( 85 . 37%、100%、83 . 33%、96. 43%,respectively,P=0. 381),and the serum β-HCG level at the hospitalized time and its decrease 2~3 days after operation,hemorrhage,operative duration showed no statistically signif-icant difference(P>0. 05 for all),although the hospital stays and therapeutic cost showed statis-tically significant difference(P=0. 000 both),among A1,A2,A3,and A4. The rate of therapeu-tic success in group C1 and C2 was 100% both. Within Group C,the serumβ-HCG level at the hospitalized time and its decrease 2~3 days after operation and therapeutic cost showed statisti-cally significant difference(P<0. 05 for all),although the hemorrhage,operative duration and the hospital stays showed no statistically significant difference ( P>0 . 05 for all ) . Conclusion:Appropriate choice of different method of treatment based on uterine ultrasonography and the se-rum β-HCG level at the hospitalized time all resulted in similarly good clinical outcomes. In drug therapy followed by dilatation and curettage whether it was used of MTX,trichosanthin or mifepristone,the clinical efficiency was similar,the hospital stays was prolonged,and the thera-peutic cost was increased. UAE followed by dilatation and curettage could reduced the operative hemorrhage,but UAE preoperatively could not in CSP abdominal lesion resection combined with repair.关键词
子宫疤痕妊娠/治疗/甲氨蝶呤/子宫动脉栓塞Key words
Cesarean scar pregnancy/Therapy/Methotrexate/Uterine arterial emboli-zation分类
医药卫生引用本文复制引用
连成瑛,陈秀娟,林元,吴茜,陈溶鑫,温芳虹,林苹,陈蕊..224例剖宫产术后子宫疤痕妊娠不同治疗方法的临床疗效分析[J].现代妇产科进展,2016,25(8):603-607,5.基金项目
福建省临床重点专科建设项目资助(No:2012149) （No:2012149）
