子宫瘢痕早期妊娠107例临床治疗研究

Study of the clinical treatments on 107 cases with uterine scar early pregnancy

目的探讨不同方法治疗子宫瘢痕早期妊娠(USEP)的疗效。方法收集107例USEP患者的资料,利用Logistic回归分析法回顾分析药物治疗、手术治疗及子宫动脉栓塞(UAE)等方法对USEP的治疗作用。结果药物治疗、手术治疗及UAE等方法均安全有效,全组患者均治愈出院,随访未见阴道不规则流血;患者的生产次数(x珋=1.20±0.47次)及治疗前血人绒毛膜促性腺激素β亚单位(β-HCG)值(M=1 175 ng/ml)是采取UAE治疗的有效决定因素;米非司酮、宫外孕Ⅱ号方及开腹子宫瘢痕妊娠物清除加子宫瘢痕修补手术等3种治疗方法与UAE术的疗效有效相关;UAE术可有效减少USEP治疗后出血量。结论 USEP患者可采取药物治疗、手术治疗及UAE术等方法,有生产史且β-HCG值1 175 ng/ml以上的USEP患者是行UAE术的指征;β-HCG值1 175 ng/ml以上的经产妇USEP患者采用UAE术联合米非司酮或宫外孕Ⅱ号方或开腹子宫瘢痕妊娠物清除加子宫瘢痕修补手术是有效的治疗方法。

Objective To explore the treatment effects of uterine artery embolization （UAE） combined with medi- cations or operation treatments about uterine scar early pregnancy （USEP）. Methods Retrospective analysis was of the treatment effects of medications, operation treatments and UAE for 107 cases of USEP using Logistic regres- sion models. Results Drug therapy, operation therapy and UAE were all safe and effective. All the patients were cured and without follow-up irregular vaginal bleeding. The time of productions （x = 1.2 ±0. 47 ） and the number of human chorionic gonadotrophin-β （β-HCG） value （M = 1175ng/ml） before treatments were effective determine- ing factors of UAE to the treatments of USEP. Mifepristone, No. Ⅱ of ectopic pregnancy and open operation for the uterine scar pregnancy with the removal of pregnancy and uterine scar repair all showed effective correlation to UAE. UAE effectively reduced the amount of bleeding after treatments. Conclusion USEP patients can been trea- ted by the drug therapy, operation therapy and UAE method, USEP patients with production history and β-HCG Value larger than 1175ng/ml before treatments should be treated by UAE combined with mifepristone or No. II of ectopic pregnancy or open operation for the uterine scar pregnancy with the removal of conceptus and the cesarean incisionrepair.