经阴道超声引导下胚胎抽吸术治疗剖宫产瘢痕妊娠的临床研究

Clinical study of transvaginal ultrasound guided embryo aspiration in the treatment of cesarean scar pregnancy

目的探讨经阴道超声引导下胚胎抽吸术治疗剖宫产瘢痕妊娠的临床价值。方法选择2016年1月至2017年9月西宁市妇幼保健计划生育服务中心诊治的76例剖宫产瘢痕妊娠患者为研究对象。按照不同治疗方法,将其分为观察组和对照组。观察组40例患者,行甲氨蝶呤(methotrexate,MTX)联合经阴道超声引导下胚胎抽吸术;对照组36例患者,行MTX+子宫动脉栓塞术+清宫术治疗。比较两组患者手术相关指标、血清人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)水平变化、术后并发症发生情况等。结果观察组患者手术时间、住院时间、治疗费用和术后阴道流血时间均明显低于对照组患者,其差异均具有统计学意义(均P<0.05);治疗后,两组患者血清β-HCG水平均明显降低,且观察组患者血清β-HCG水平、血清β-HCG恢复正常的时间均明显低于对照组患者,其差异均具有统计学意义(均P<0.05);观察组患者术后并发症和不良反应发生率明显低于对照组患者,其差异均具有统计学意义(均P<0.05);观察组患者术后1周复查B超均显示盆腔低回声包块明显缩小和消失,对照组1例患者有盆腔包块。结论MTX联合经阴道超声引导下胚胎抽吸术治疗剖宫产瘢痕妊娠是一种简单、有效、安全的治疗方案,可以明显减少治疗费用,减少术后并发症发生率。

Objective To investigate the clinical value of transvaginal ultrasound guided embryo aspiration in the treatment of cesarean scar pregnancy(CSP).Methods 76 CSP patients treated in Xi'ning Maternal and Child Health Center from January 2016 to September 2017 were selected as the study objects.According to different treatment methods,they were divided into observation group and control group.40 patients in the observation group underwent methotrexate(MTX)+transvaginal ultrasound-guided embryo aspiration.36 patients in the control group were treated with MTX+uterine artery embolization+palace purgation.The operation related indicators,human chorionic gonadotropin(d-hcg)level changes and postoperative complications were compared between the two groups.Results The operative time,hospitalization time,treatment cost and postoperative vaginal bleeding time in the observation group were significantly lower than those in the control group,all with statistically significant differences(all P<0.05).After treatment,the levels of serumβ-HCG in the two groups were significantly decreased(P<0.05),and theβ-HCG level and recovery time of serumβ-HCG in the observation group were significantly lower than those in the control group,all with statistically significant differences(all P<0.05).The incidence of postoperative complications and adverse reactions in the observation group were significantly lower than those in the control group,all with statistically significant differences(all P<0.05).At a week after operation,B-ultrasound showed that the pelvic hypoechoic mass was significantly reduced in the observation group,and a patient in the control group had pelvic masses.Conclusions MTX combined with transvaginal ultrasound guided embryo aspiration is a simple,effective and safe treatment for CSP,which can significantly reduce the treatment cost and the incidence of postoperative complications.