3种方案治疗子宫瘢痕妊娠的疗效对比

Comparison of three kinds of uterine scar pregnancy treatment program

目的对比观察药物治疗、清宫术、宫腔镜治疗3种子宫疤痕妊娠治疗方案的临床疗效。方法选择医院2015年8月-2017年8月期间进行子宫疤痕妊娠治疗的23例患者为观察对象,其中8例采用氨甲喋呤联合米非司酮药物治疗(A组),6例采用清宫术治疗(B组),9例采用宫腔镜治疗(C组),比较3组患者h CG恢复正常所需时间以及治疗的成功率。结果 A组患者治疗后h CG值恢复所需时间为(24.36±6.13)d;B组患者治疗后h CG值恢复所需时间为(35.10±8.24)d;C组患者治疗后h CG值恢复所需时间为(21.64±5.71)d。3组患者中C组h CG恢复最快,A组、C组与B组比较差异有统计学意义(P<0.05)。A组患者治疗成功率为75.0%(6/8);B组患者治疗成功率为33.3%(2/6);C组患者治疗成功率为88.9%(8/9),A组、C组与B组比较差异均有统计学意义(P<0.05)。结论在子宫疤痕妊娠患者的治疗过程中,需要根据患者具体情况实施个性化的治疗方案,在采用药物治疗、清宫术以及宫腔镜治疗3种方案中,药物治疗有效,但所需治疗时间长于后两种治疗方法,清宫术治疗则容易出现严重的大出血,宫腔镜治疗对患者造成创伤小、恢复快,因此在治疗过程中需要充分考虑患者情况采取治疗措施。

Objective To compare and observe the clinical efficacy of three kinds of uterine scar pregnancy regimen.Methods 23 patients who were treated for uterine scar pregnancy during the period from August 2015 to August 2017 were selected as the research subjects. 8 cases were treated with methotrexate and mifepristone（ group A）,6 cases were treated with complete curettage of uterine cavity（ group B）,and 9 cases were treated with hysteroscopy（ group C）. The time required for the recovery of h CG and the success rate of the treatment were compared among the 3 groups. Results After treatment,the time required for the recovery of h CG in group A was（ 24. 36 ± 6. 13） d,group B was（ 35. 10 ± 8. 24） d,and group C was（ 21. 64 ±5. 71） d. The fastest recovery of h CG among the three groups was group C,and there were significant differences between group A,group C and group B（ P〈0. 05）. The success rate of group A was 75%（ 6/8）; the success rate of group B was 33. 3%（ 2/6）; the success rate of group C was 88. 9%（ 8/9）,and there were significant differences between group A,group C and group B（ P〈0. 05）. Conclusion In the treatment of patients with uterine scar pregnancy,individualized treatment needs to be implemented according to the patient＇s specific circumstances. Among the three treatment programs： drug therapy,complete curettage of uterine cavity and hysteroscopy,the drug treatment is effective,but the required treatment time longer than the latter two treatments. The treatment of complete curettage of uterine cavity is easy to have severe bleeding. Hysteroscopy is a small and quick recovery for the patients. Therefore,in the process of treatment,we need to take full consideration of the patient＇ s condition to take treatment measures.