中国全科医学2024，Vol.27Issue(12)：1475-1479,1486,6.DOI:10.12114/j.issn.1007-9572.2023.0476
不同类型剖宫产瘢痕妊娠的病例特点与诊治分析
Clinical Characteristics and Management of Different Types of Cesarean Scar Pregnancy
摘要
Abstract
Background The current classification of cesarean scar pregnancy(CSP)is only based on the ultrasonic characteristics.At present,there is a lack of analysis and summarization of the clinical characteristics of different types of CSP cases under this classification criteria.Objective To investigate the clinical characteristics and management variance of different types of CSP.Methods A total of 862 patients with CSP admitted to the Department of Obstetrics and Gynecology,Peking University Third Hospital from July 2014 to June 2022 were enrolled and divided into the type Ⅰ,type Ⅱ and type Ⅲ groups.The clinical characteristics and indicators of diagnosis and treatment were analyzed retrospectively.Results Among the total CSP patients,36.5％(315/862)were typeⅠ,53.1％(458/862)were typeⅡ,and 10.3％(89/862)were type Ⅲ.The incidence of abdominal pain was 24.2％(209/862)and vaginal bleeding was 65.0％(560/862)in CSP patients.There was no statistically significant difference in the age,history of pregnancy and childbirth,and proportion of previous uterine cavity surgery among the three groups of patients(P>0.05).There was no significant difference in abdominal pain(P=0.261)and vaginal bleeding(P=0.062)among the three groups.In type Ⅲ patients,the average gestational age was 55(46,64)days,the average diameter of gestational mass was 29.6(19.1,43.3)mm,and the serum β-HCG level was 60 673(17 164,122 203)mU/mL at diagnosis.The proportion of patients who needed adjuvant pharmacologic embryocidal therapy,laparoscopic surgery and uterine artery occlusion was 27％(24/89),33.7％(30/89)and 32.6％(29/89),respectively.The operation duration was 101(67,125)min,the hospitalization duration was 4(3,7)days,and the treatment cost was 11 933.7(8 760.7,15 250.6)CNY for typeⅢpatients.The accumulated bleeding volume within 24 hours after surgery,the proportion of patients with perioperative bleeding≥200 mL and requiring blood transfusion was 24.7％(22/89)and 7.9％(7/89)in type Ⅲpatients,respectively,which were higher than the other two groups(P<0.001).The incidence of persistent CSP was 3.1％(27/862)in all patients,and there was no significant difference among the three groups(χ2=3.353,P=0.187).Conclusion There is no significant difference in age,maternal history,gravidity and parity,and clinical characteristics such as abdominal pain and vaginal bleeding in patients with different types of CSP.The treatment of typeⅠand typeⅡpatients is less invasive and consumes less medical resources,while typeⅢpatients consume more medical resources and have high requirements for multidisciplinary team and individualized management.The prognosis of all three types of patients is ideal after standardized management.关键词
剖宫产术/瘢痕妊娠/体征和症状/治疗/预后Key words
Cesarean section/Scar pregnancy/Signs and symptoms/Treatment/Prognosis分类
医药卫生引用本文复制引用
王超,侯征,李华军,李蓉,乔杰..不同类型剖宫产瘢痕妊娠的病例特点与诊治分析[J].中国全科医学,2024,27(12):1475-1479,1486,6.基金项目
国家重点研发计划"生育健康及妇女儿童健康保障"重点专项(2022YFC2702500) （2022YFC2702500）
