75例剖宫产术后子宫瘢痕妊娠的治疗方案选择及疗效分析

Selection of treatment protocols and outcome analysis for 75 cases of cesarean scar pregnancy

目的:探讨剖宫产术后子宫瘢痕妊娠(CSP)的治疗方案选择,并分析其疗效。方法:回顾性选取2016年6月至2018年12月我院收治的75例CSP患者的临床资料,其中55例行药物预处理(单独或联合使用甲氨蝶呤及米非司酮)+B超引导下清宫术设为A组,7例行开腹病灶清除术设为B组,13例行经阴道病灶清除术设为C组。分析对比三组手术时间、手术出血量、住院时间、人绒毛膜促性腺激素(β-HCG)水平复常时间、月经复常时间、术后并发症发生率。结果:三组手术时间、手术出血量、住院时间对比,差异有统计学意义(P<0.05),两两比较,A组手术时间、住院时间较B组、C组短,手术出血量较B组、C组少,C组手术时间、住院时间较B组短,手术出血量较B组少,差异有统计学意义(P<0.05);三组β-HCG水平复常时间、月经复常时间对比,差异无统计学意义(P>0.05);三组并发症发生率对比,差异无统计学意义(P>0.05)。结论:药物预处理+清宫术、开腹病灶清除术、经阴道病灶清除术均可有效治疗CSP,安全性良好,需根据患者病情进行综合评估,选择适合患者自身的最佳治疗方案。

Objective:To explore for selection of the treatment protocol for cesarean scar pregnancy(CSP),and to determine the curative effect.Methods:The clinical data of 75 CSP patients admitted to our hospital between June 2016 and December 2018 were retrospectively included in the study.Among them,55 patients pretreated with drugs(alone or in combination with Methotrexate and Mifepristone)+B-ultrasound guided uterine curettage were included as group A;7 patients undergoing transabdominal debridement were included as group B;and 13 patients undergoing transvaginal debridement were included as group C.The operation time,intraoperative blood loss,length of hospital stay,time to recovery of normal human chorionic gonadotropin(β-HCG)level,time to recovery of normal menstruation and incidence of complications were analyzed and compared among the three groups.Results:There were statistically significant differences in the operation time,intraoperative blood loss,length of hospital stay among the three groups(P<0.05).The operation time and length of hospital stay in group A were shorter than those in group B and group C,and the intraoperative blood loss in group A was less than that in group B and group C.The operation time and length of hospital stay in group C were shorter than those in group B,and the intraoperative blood loss in group C was less than that in group B,with statistically significant differences(P<0.05).There were no statistically significant differences in the timeto recovery of normalβ-HCG level and time to recovery of normal menstruation among the three groups(P>0.05).There was no statistically significant difference in the incidence of complications among the three groups(P>0.05).Conclusion:Drug pretreatment+uterine curettage,transabdominal debridement and transvaginal debridement may effectively treat CSP with good safety.A comprehensive assessment based on the patient’s condition is required to select the optimal treatment protocol for the patient.