不同类型子宫疤痕妊娠处理的临床疗效分析

Clinical effect of different types of cesarean scar pregnancy treatments

目的探讨不同类型子宫疤痕妊娠处理方法的临床疗效。方法回顾性分析南方医科大学附属佛山市妇幼保健院2010年1月至2016年12月收治的子宫疤痕妊娠375例,根据Vial分型及血β-人绒毛膜促性腺激素(β-hCG)、孕酮值将患者分为4组,A组患者行宫腔镜检查+清宫术,B组行甲氨蝶呤(MTX)预处理+宫腔镜检查+清宫术,C组行妊娠病灶切除+子宫瘢痕修补术,D组行MTX预处理+妊娠病灶切除+子宫瘢痕修补术,比较4组的疗效。结果 4组手术成功率均在95%以上,无严重并发症发生,手术成功率比较无统计学差异(χ~2=3.81,P>0.05),但各组术中出血量、住院天数比较有显著性差异(F值分别为3.71、3.80,均P<0.01),经阴道子宫疤痕妊娠病灶切除术+子宫修补术和MTX治疗+经阴道子宫疤痕妊娠病灶切除术+子宫修补术出血量较多,且住院时间长(F值分别为3.71、3.80,均P<0.01)。结论根据患者的具体情况,采取个体化治疗方案,可以使子宫疤痕妊娠得到有效治疗。

Objective To explore the clinical effect of different types of cesarean scar pregnancy（CSP）treatment.Methods Retrospective analysis was conducted among 375 cases of CSP treated in Foshan Maternal and Child Health Hospital during January 2010 to December 2016,and the patients were divided into 4 groups according to the classifications of Vial,β-hCG and progesterone level.Patients in group A accepted hysteroscopy and curettage,those in group B received pretreatment with MTX,hysteroscopy examination and curettage,those in group C performed transvaginal surgery and uterine cicatricial repair,and those in group D accepted pretreatment with MTX,transvaginal surgery and uterine cicatricial repair.Treatment effect was compared among four groups.Results The cure rate of 4 groups was over 95%,and no serious complications occurred.There was no significant difference in cure rate（χ^2=3.81,P〉0.05）,but the differences were significant in the amount of blood loss in surgery and hospital stay among four groups（Fvalue was 3.71 and 3.80,respectively,both P〈0.01）.In transvaginal uterine scar lesions resection plus uterine repair as well as MTX treatment plus transvaginal uterine scar lesions resection and uterine repair,there was more blood loss and hospital stay was longer.ConclusionIndividualized treatments should be taken according to patients＇ situation,which enables CSP be treated effectively.