两种不同方式治疗子宫疤痕妊娠效果分析

Clinical analysis of two methods in the treatment of cesarean scar pregnancy

目的分析子宫疤痕妊娠两种不同治疗方法的临床疗效。方法回顾性分析2015年1月至2018年1月深圳市第二人民医院妇科收治的36例子宫疤痕妊娠患者的临床资料,其中B超引导下肌肉及孕囊内注射甲氨蝶呤(MTX)行清宫术15例(MTX组),腹腔镜下子宫疤痕妊娠病灶清除子宫修复整形术21例(腹腔镜组)。比较两组患者手术前孕囊的大小、疤痕厚度、术前绒毛膜促性腺激素(HCG)水平以及孕龄、手术中出血量、手术时间、手术后阴道出血情况、住院时间、住院费用等情况。结果两组患者术前的孕龄,年龄,疤痕厚度等资料比较差异均无统计学意义(P>0.05);术中MTX组患者的出血量为(33.0±15.99) mL,明显多于腹腔镜组的(16.0±13.99) mL,差异有统计学意义(P<0.05);术后MTX组患者的住院时间为(16.93±6.11) d,明显长于腹腔镜组的(5.14±1.15) d,差异有统计学意义(P<0.05);MTX组患者的阴道出血时间为(22.26±4.83) d,明显长于腹腔镜组的(8.52±3.10) d,差异有统计学意义(P<0.05)。结论两种治疗方式各有利弊,MTX是一种适应范围较广的治疗方法,而腹腔手术则是一种有效而快速的方法,但对术者及器械要求均较高,不合适基层医院使用。

Objective To evaluate the clinical efficacy of methotrexate（MTX） and laparoscopic surgery in the treatment of cesarean scar pregnancy. Methods The clinical data of 36 patients who had received MTX and laparoscopic surgery between Jan. 2015 and Jan. 2018 in Shenzhen Second Hospital were analyzed, including 15 patients receiving B-ultrasound guided MTX treatment and 21 undergoing laparoscopic surgery. The pre-, intra-and postoperative conditions, including pregnant sac size, thickness of the scar, HCG level, gestation age, intraoperative blood loss, operative duration, vaginal bleeding after operation, length of hospital stay, and hospitalization costs, were compared between the two groups. Results There was no significant difference in gestational age, age, and thickness of the scar between the two groups（P〉0.05）. Compared with the patients receiving laparoscopic surgery, the patients undergoing MTX treatment had less blood loss（33.0±15.99） m L vs（16.0±13.99） mL, longer length of hospital stay（16.93±6.11） days vs（5.14±1.15） d, and longer vaginal bleeding time（22.26±4.83） days vs（8.52±3.10） d（P〈0.05）. Conclusion Both the two treatments have their advantages and disadvantages. MTX can be widely used, while laparoscopic surgery is effective and rapid but not suitable for primary hospitals because of its high requirements for the operators and instruments.