241例剖宫产术后子宫瘢痕妊娠不同治疗方法临床研究

Clinical study on different therapies for 241 cases with cesarean scar pregnancy

目的:比较剖宫产术后切口瘢痕妊娠不同治疗方法的有效性。方法:将241例切口瘢痕妊娠患者分为孕囊穿刺组(120例)和动脉栓塞组(121例),比较各组治疗后疗效、血清β-人绒毛膜促性腺激素(β-hCG)恢复至正常时间、出血量、住院时间、转经时间、住院费用以及激素水平。结果:孕囊穿刺组和动脉栓塞组治愈率分别为95.0%和94.2%。动脉栓塞组血β-HCG水平下降快于孕囊穿刺组。孕囊穿刺组和动脉栓塞组血β-HCG恢复至正常时间分别为(49.3±5.4)天和(23.0±3.4)天,两组比较差异有统计学意义(P<0.01)。孕囊穿刺组和动脉栓塞组出血量分别为(71.27±178.81)ml和(30±40)ml,两组比较差异有统计学意义(P<0.01)。孕囊穿刺组和动脉栓塞组住院时间分别为(31.7±5.1)天和(18.3±5.9)天,两组比较差异有统计学意义(P<0.01)。孕囊穿刺组和动脉栓塞组转经时间分别为(49.8±7.3)天和(33.7±12.7)天,两组比较差异有统计学意义(P<0.05)。孕囊穿刺组和动脉栓塞组治疗费用分别为(3 657.12±29.36)元和(10173.47±34.91)元,两组比较差异有统计学意义(P<0.01)。两组治疗前后激素水平比较差异无统计学意义(P>0.05)。结论:子宫动脉栓塞术的疗效明显优于孕囊穿刺术,血β-HCG水平恢复快、出血量少、住院时间短、月经恢复快,是目前值得推广应用的技术。

Objective： To compare the efficacies of different therapies for cesarean scar pregnancy （CSP） . Methods： A total of 241 CSP patients were divided into gestational sac puncture group （120 patients） and artery embolization group （120 patients）, then the curative effects, the times for serum 13 - human chorionic gonadotropin （ 13 - hCG） return to normal, the amounts of blood loss during opera- tion, the hospitalization times, the times for menstrual recovery, the hospitalization expenses, and the levels of hormones in the two groups were compared. Results： The cure rates in gestational sac puncture group and artery embolization group were 95.0% and 94. 2%, respec- tively. The descent speed of serum 13 -HCG level in artery embolization group was quicker than that in gestational sac puncture group. The times for serum J3 - hCG return to normal in gestational sac puncture group and artery embolization group were （ 49. 3 ± 5.4 ） days and （23.0 ±3.4） days, respectively, there was statistically significant difference between the two groups （P 〈0. 01 ） . The amounts of blood loss during operation in gestational sac puncture group and artery embolization group were （71.27 ±178. 81 ） ml and （30±40） ml, respec- tively, there was statistically significant difference between the two groups （P 〈 0. 01 ） . The hospitalization times in gestational sac puncture group and artery embolization group were （31.7 ±5.1 ） days and （18.3 ±5.9） days, respectively, there was statistically significant differ- ence between the two groups （ P 〈 0.01 ） . The times for menstrual recovery in gestational sac puncture group and artery embolization group were （49. 8 ±7.3） days and （33.7 -＋ 12.7） days, respectively, there was statistically significant difference between the two groups （P 〈 0. 05 ） . The hospitalization expenses in gestational sac puncture group and artery embolization group were （ 3 657. 12 ~ 29. 36 ） Yuan and （ 10 173.47 ~ 34.91 ） Yuan, respectively, there was statistically significant difference between the two groups （ P 〈 0. 01 ） . There was no statistically significant difference in the levels of hormones between before and after treatment in the two groups （ P 〉 0. 05 ） . Conclusion： The curative effect of uterine artery embolization was better than that of gestational sac puncture, the recovery of serum 13 - hCG was faster, the blood loss during operation was fewer, the hospitalization time was shorter, the menstrual recovery was quicker, so uterine artery emboli- zation is a technique worthy to be popularized and applied at present.