剖宫产瘢痕妊娠应用不同治疗方法临床分析

Clinical Outcome Analysis of Different Treatment Methods for Patients with Different Types of Cesarean Scar Pregnancy

目的探讨不同分型的剖宫产瘢痕妊娠应用不同治疗方法的临床效果。方法回顾性分析北京某三甲医院、北京平谷区某医院2014年1月-2017年7月243例CSP。按照Vial国际分型分为内生型与外生型,每型根据治疗方案分为4组:1组:MTX+子宫动脉栓塞(UAE)+超声监测清宫;2组:MTX+超声监测清宫;3组:UAE+超声监测清宫;4组:直接超声监测清宫。比较内生型及外生型CSP在不同治疗方法下的临床结局。结果⑴内生型CSP在不同治疗方法中手术时间、术中出血量、治疗成功率差异无统计学意义(P>0.05)。⑵外生型CSP第1组和第3组术中出血量比2组减少(P<0.05);第1组血清β-HCG转阴时间和包块吸收时间短于其他2组(P<0.05);外生型CSP的治疗成功率1组和3组高于2组(P<0.05)。⑶二型CSP第3组和第4组的住院时间最短(P<0.05),第4组的住院费用少于其他3组(P<0.05)。结论内生型CSP可直接超声监测下清宫,缩短住院时间并减少患者费用;外生CSP应进行MTX预处理,并在清宫术前行UAE,以减少术中出血及提高治疗的成功率。

Objective To explore the clinical effect and treatment outcome of different treatment methods for different types ofcesarean scar pregnancy. Methods Retrospective analysis of 243 cases of scar pregnancy in Beijing chaoyang hospital and Beijing pinggu district hospital.Those patients were hospitalized from January2014 to July 2017.According to the Vial international classification, Those patients were divided into endogenous and exogenous types, and each type was divided into four groups according to the treatment plan. Group 1：Methotrexate（MTX）＋Uterine artery embolization（UAE）＋Sonogrphy directed in situs aspiration. Group 2：MTX＋Sonogrphy directed in situs aspiration. Group 3： UAE＋Sonogrphy directed in situs aspiration. Group 4：Sonogrphy directed in situs aspiration. To compare the clinical outcomes of endogenous and exogenous scar pregnancy in different treatment methods. Results（1）There was no statistically significant difference in the treatment success rate of endogenous CSP in different treatment methods（P〉0.05）.（2）Exogenous CSP patients with group 1 and group 3 had less intraoperative blood loss than those in other groups（P〈0.05）. In the first group,the time and duration of serum β-HCG in the patients were shorter than those in the other 3 groups（P〈0.05）. The treatment success rate of patients with exogenous CSP was higher than that in group 1 and 3, and the difference was statistically significant（P〈0.05）.（3）Patients with CSP in group 3 and 4 were the shortest hospitalizations（P〈0.05）. Patients in the fourth group spent less than the other three groups（P〈0.05）. Conclusion Endogenous CSP patients can be operated directly under ultrasonic monitoring, which can shorten hospital stay and reduce patients＇ costs.Patients with exogenous CSP should undergo MTX pretreatment and go to the UAE before surgery to reduce hemorrhage and improve the rate of treatment.