药物、子宫动脉栓塞及高强度聚焦超声联合清宫对剖宫产瘢痕妊娠的疗效比较

Comparison of curative effects of drug,uterine artery embolization and high intensity focused ultrasound combined with uterine curettage in treatment of cesarean scar pregnancy

目的：探讨剖宫产瘢痕妊娠（CSP）使用药物、双侧子宫动脉栓塞术（UAE）及高强度聚焦超声（HIFU）行保守治疗的临床疗效，为临床治疗CSP提供更好的治疗方法。方法：收集2008年1月～2012年12月收治的220例CSP患者分为3组：A组给予甲氨蝶呤或米非司酮药物治疗48例，B组行UAE治疗142例，C组行HIFU治疗30例。比较3组治愈率、β-hCG恢复时间、平均住院天数、平均费用、阴道出血量，并进行随访。结果：3种治疗方法疗效相同（P〉0．05），治疗后血β-hCG恢复时间、平均住院天数、平均费用、阴道出血量有统计学差异（P〈0．05），其中A组平均费用最少、平均住院时间长、阴道出血量最多，B组血β-bEG恢复时间最短、平均费用最高，C组血β-hCG恢复时间最长、平均住院时间最短、阴道出血量最少。结论：HIFU治疗CSP的安全性、有效性及费用方面优于其他两种方法，是CSP的有效治疗方法。

Objective： To explore the clinical efficacies of conservative treatment with drug, biliteral uterine artery embolization （UAE） and high intensity focused ultrasound （HIFU） in treatment of cesarean scar pregnancy （CSP）, provide a better therapy for CSP in clinic. Methods： A total of 220 CSP patients treated in the hospital from January 2008 to December 2012 were collected and divided into three groups： 48 patients in group A were treated with methotrexate or mifepristone, 142 patients in group B were treated with UAE, and 30 patients in group C were treated with HIFU. The curative rates, recovery times ofβ- human chorionic gonadotropin （ β- bCG）, the mean hospitalization days, the mean medical fees, and the amounts of vaginal bleeding in the three groups were compared, the patients in the three groups were followed up. Results： There was no statistically significant difference in the curative effect among the three groups （P 〉 0. 05 ）, there were statistically significant differences in the recovery times of blood β-hCG, the mean hospitalization day, the mean medical fee, and the amount of vaginal bleeding between before and after treatment （ P 〈 0. 05 ）, the mean medical fee in group A was the lowest, the mean hospitalization day in group A was the longest, the amount of vaginal bleeding in group A was the highest, the recovery time of blood β-hCG in group B was the shortest, the mean medical fee in group B was the highest, the recovery time of blood β- hCG in group C was the longest, the mean hospitalization day in group C was the shortest, the amount of vaginal bleeding in group C was the lowest. Conclu- sion： The safety, effectiveness, and medical fee of HIFU in treatment of CSP are superior to the other two methods, which is a effective therapeutic method for CSP.