剖宫产瘢痕妊娠两种保守性治疗方法疗效比较

Effect comparison of different conservative treatments for cesarean scar pregnancy

目的比较剖宫产瘢痕妊娠(CSP)的两种保守治疗方法的疗效。方法回顾性分析杭州师范大学附属医院2009年1月至2012年12月收治的51例CSP患者,根据治疗方法的不同分为两组:化疗组为甲氨蝶呤(MTX)治疗后行清宫术30例;介入组为子宫动脉MTX灌注加栓塞后清宫术21例。比较两组的治疗疗效、术中出血量、住院天数、血人绒毛膜促性腺激素(HCG)转为正常的时间以及不良反应发生的情况。结果介入组保守治疗成功率(95.2%)高于化疗组(56.7%)(P<0.05),介入组住院时间[(11.8±2.7)d]明显短于化疗组[(23.2±5.2)d](P<0.05),但介入组不良反应的发生率(71.4%)高于化疗组(13.3%)(P<0.05)。介入组出血量[(23.5±7.1)m L]与化疗组[(20.1±6.9)m L]比较差异无统计学意义(P>0.05),介入组血HCG恢复正常的时间[(23.0±2.6)d]与化疗组[(23.8±3.0)d]比较差异也无统计学意义(P>0.05)。结论 MTX治疗后行清宫术不失为有效的治疗方法,而子宫动脉MTX灌注加栓塞后清宫术更快捷,疗效更明显。

Objective To compare the outcomes of two different conservative treatments for cesarean scar pregnancy. Methods Retrospective analysis of 51 patients with cesarean scar pregnancy admitted to our hospital from January 2009 to December 2012. Thirty patients received systemically methotrexate injection combined with dilation and curettage （chemotherapy group）;21 patients underwent uterine artery embolization in combination with local injection of methotrexate followed by dilation and curettage （intervention group）. Treatment effect （success rates）, blood loss during operation, hospitalization stay, time for blood β-HCG recovery and adverse effect were compared between two groups. Results The success rate of conservative treatment in intervention group （95.2%） was higher than that of chemotherapy group （56.7%） （P〈0.05）. The hospitalization stay in intervention group [（11.8 ±2.7）d] was shorter than that of chemotherapy group[（23.2±5.2）d]（P〈0.05）. Meanwhile, the incidence of adverse effect in intervention group （71.4%） was higher than that of chemotherapy group （13.3%）（P 〈 0.05）. No significant differences were observed in blood loss and time for blood β-HCG recovery between these two groups （P 〉 0.05）. Conclusion Systemically methotrexate injection combined with dilation and curettage is effective in cesarean scar pregnancy treatment, but uterine artery embolization in combination of local injection of methotrexate followed by dilation and curettage is more effective with shorter hospitalization stay.