剖宫产瘢痕妊娠127例临床分析

Analysis of 127 cases of cesarean scar pregnancy

目的:探讨剖宫产瘢痕妊娠(CSP)的有效治疗方法。方法:回顾分析2013年1月至2015年3月复旦大学附属妇产科医院收治的127例CSP患者的临床资料,按治疗方法分组:单纯超声引导下清宫术组(A组)38例,行双侧子宫动脉化疗栓塞后超声引导下清宫术组(B组)72例,宫腹腔镜联合治疗组(C组)17例。比较3组的临床资料和社会经济学指标;分析CSP预后的相关因素。结果:A组患者的病灶体积为(9.76±2.30)cm3,治疗前血β-HCG为(40983±11132.40)m IU/ml,术中出血(48.55±16.07)ml,住院天数(4.63±0.29)天,住院费用(5171.57±730.41)元。B组患者的病灶体积为(27.33±6.47)cm3,治疗前血β-HCG为(76771.23±7582.95)m IU/m L,术中出血(42.32±15.15)ml,住院天数(6.42±0.28)天,住院费用(11113.41±405.94)元。C组患者的病灶体积为(65.82±29.61)cm3,治疗前血β-HCG为(47010.10±112106.42)m IU/m L,术中出血(267.65±113.41)ml,住院天数(6.82±0.52)天,住院费用为(18018.40±1209.61)元。3组的病灶体积比较,差异有统计学意义(P<0.05)。C组的术中出血量高于A、B组,差异有统计学意义(P均=0.003);A、B组比较,差异无统计学意义(P>0.05);3组的治疗成功率比较,差异无统计学意义(P>0.05),而住院费用比较,差异均有统计学意义(P<0.05)。A组的住院时间与B、C组比较,差异有统计学意义(P=0.0001、0.0009);B、C组比较差异则无统计学意义(P=0.4936)。多因素回归分析提示,停经天数、CSP超声分型、病灶体积、血β-HCG水平与CSP预后相关。结论:临床工作中可根据超声分型、病灶体积、血β-HCG水平等综合考虑给予个体化治疗,但早期发现、正确诊断是合理治疗的关键。

Objective： To evaluate the treatment method of cesarean scar pregnancy（CSP）.Methods： 127 cases who were diagnosed as CSP in Obstetrics and Gynecology Hospital of Fudan University from Jan.2013 to Mar.2015 were studied retrospectively.The patients were divided into three groups： 38 cases named A group were treated by suction curettage under ultrasound guidance; 72 cases named B group underwent bilateral uterine artery chemoembolization（BUACE） ＋ suction curettage under ultrasound guidance; C group which included 17 cases who were received laparoscopy and hysteroscopy-combined surgery as treatment of CSP.The baseline characters,surgical clearance rates,complications,cost and durations of hospitalization and recovery qualities of patients from these groups were compared,factors affecting prognosis of CSP were investigated.Results： The volume of lesions for these three groups was（9.76 ±2.30）cm3,（27.33±6.47） cm3,（65.82±29.61） cm^3 respectively,while the significantly differences were found among three groups.The serum level of β-h CG before treatment were（40983 ±11132.40） m IU/ml,（76771.23 ±7582.95） m IU/ml,（47010.10 ±112106.42） m IU/ml respectively.Bleeding loss were（48.55 ±16.07） ml in group A;（42.32 ±15.15） ml in group B and（267.65±113.41） ml in group C.Group A and group B were both significantly less than group C,while there was no significant difference among group A and group B.The expense were（5171.57 ± 730.41） yuan in group A,which were significantly less than those in group B（11113.41±405.94） yuan and in group C（18018.40±1209.61） yuan.Hospital stay were significantly longer in group B（6.42 ±0.28days） and group C（6.82 ±0.52days） compared with the group A（4.63 ±0.29days）.Multivariate regression analysis showed that gestational age,lesion volume,serum level of β-h CG may be factors of prognosis of CSP.Conclusion： Early diagnosis and early treatment remain the key for a successful treatment of CSP.Different therapeutic modalities may be selected according to patient conditions.