剖宫产术后子宫瘢痕妊娠60例临床分析

Clinical Analysis of 60 Cases of Uterine Scar Pregnancy After Cesarean Section

目的探讨剖宫产术后子宫瘢痕部位妊娠临床诊断及治疗方法。方法收集整理2013年1月—2017年1月我院妇科收治的60例剖宫产术后子宫瘢痕部位妊娠患者的病历,回顾性分析其临床资料,把药物治疗加彩超引导清宫术作为保守治疗组,把经阴道病灶切除加子宫修补术作为手术治疗组,比较两组术中出血量、住院时间、病灶缩小时间、血β-HCG值恢复时间及手术成功率等数据,为剖宫产术后子宫瘢痕部位妊娠的诊断处理提供依据。结果60例CSP患者经两种不同的方式治疗后,保守治疗组在手术成功率和术后并发症方面与手术治疗组比较,差异无统计学意义(P>0.05);但手术治疗组在血β-HCG值恢复时间、住院时间、出血量和病灶缩小时间等显著低于保守治疗组,差异有统计学意义(P<0.05)。结论准确掌握CSP诊断和处理,对于CSP的处理,经阴道病灶切除加子宫修补术比药物治疗加彩超引导清宫术更有优势,值得基层推广应用。

Objective To investigate the clinical diagnosis and treatment of uterine scar pregnancy after cesarean section.Methods The medical records of 60 patients with uterine scar after cesarean section admitted to our department from January 2013 to January 2017 were collected.The clinical data were retrospectively analyzed.The drug treatment plus color ultrasound guided uterine curettage was used as the conservative treatment.The transvaginal lesions and uterine repair was used as the surgical treatment group.The data of intraoperative hemorrhage,hospitalization time,lesion reduction time,bloodβ-HCG recovery time and surgical success rate were compared for cesarean section.Provide a basis for the diagnosis and treatment of post-uterine scar pregnancy.Results After treatment of 60 patients with CSP in two different ways,there was no significant difference in the success rate and postoperative complications between the conservative treatment group and the surgical treatment group(P>0.05).However,the surgical treatment group in the time to recovery ofβ-HCG,hospitalization time,blood loss and time to lesion reduction were significantly lower than those in the conservative treatment group,and the difference was statistically significant(P<0.05).Conclusion Accurately master the diagnosis and treatment of CSP,for the treatment of CSP,transvaginal lesion resection and uterine repair have more advantages than drug therapy plus color ultrasound guided uterine curettage,which is worthy of promotion and application at the grassroots level.