3种不同治疗方案对剖宫产术后子宫瘢痕妊娠患者预后的影响

Effect of 3 kinds of different treatment options on the prognosis of patients with uterine scar pregnancy after cesarean section

目的探讨甲氨蝶呤（MTX）联合米非司酮药物治疗、子宫动脉栓塞术（UAE）、妊娠病灶切除术联合子宫瘢痕修补术3种不同治疗方案对剖宫产术后子宫瘢痕妊娠患者预后的影响。方法回顾性分析2009年1月～2016年1月河北省平山县人民医院收治的78例剖宫产术后瘢痕妊娠患者的临床资料，依据不同治疗方法分组。其中采用MTX联合米非司酮药物预处理患者17例为药物组，采用UAE预处理患者30例为UAE组，采用妊娠病灶切除术联合子宫瘢痕修补术治疗患者31例为联合手术组，比较3组手术时间、术中总出血量、术后血β-人绒毛膜促性腺激素（13-HCG）恢复时间、月经恢复正常时间、总医疗费用、治疗成功率及安全性。结果3组患者手术时间、术中总出血量、术后血β-HCG恢复时间、月经恢复正常时间和总医疗费用比较，差异有统计学意义（P〈0．05）。3组患者治疗成功率比较，差异有统计学意义（P〈0．05）。3组患者副作用发生率比较，差异无统计学意义（P〉0．05）。结论UAE和妊娠病灶切除术联合子宫瘢痕修补术在剖宫产术后子宫瘢痕妊娠患者中疗效更佳，且术后恢复迅速，临床上应根据具体情况选择合适治疗方案。

Objective To discuss the effect of Methotrexate （MTX） combined with Mifepristone drug treatment, uterine artery embolization （UAE） and excision of lesion of pregnancy combined with uterine scar repair of a total of 3 kinds of different treatment options on the prognosis of patients with uterine scar pregnancy after cesarean section. Methods The clinical data of 78 cases of patients with uterine scar pregnancy after cesarean section in Pingshan People＇s Hospital of Hebei Province from January 2009 to January 2016 were retrospectively analyzed, who were divided into three groups according to the different kinds of treatment methods. There were 17 patients treated with MTX combined with Mifepri- stone for pretreatment as drug group, and there were 30 cases of patients treated with UAE for pretreatment as UAE group, and there were 31 cases of patients treated with excision of lesion of pregnancy combined with uterine scar re- pair as combination operation group. Operation time, intraoperative total blood loss, postoperative blood β-HCG recov- ery time, menstrual recovery time, total medical costs, treatment success rate and safety among three groups were com- pared. Results Operation time, intraoperative total blood loss, postoperative blood β-HCG recovery time, menstrual re- covery time, total medical costs among three groups were compared, with statistical differences （P 〈 0.05）. Treatment success rate among three groups was compared, with statistical difference （P 〈 0.05）. Incidence rate of side effect a- mong three groups was compared, with no statistical difference （P 〉 0.05）. Conclusion The treatment effect of UAE and excision of lesion of pregnancy combined with uterine scar repair in patients with uterine scar pregnancy after cesarean section is better, with rapid postoperative recovery, and the appropriate treatment plan should be chosen according to the specific situations in clinic.