剖宫产瘢痕妊娠不同治疗方案临床疗效比较

Effects of different options for treating pregnant women with cesarean scar pregnancy

目的:分析不同治疗方案对剖宫产瘢痕妊娠临床疗效及预后。方法:回顾性收集本院2019年1月—2020年6月收治的剖宫产瘢痕妊娠患者102例临床资料,基于治疗方案分为甲组(20例)行甲氨蝶呤联合清宫术,乙组(29例)行阴式瘢痕妊娠病灶清除术联合子宫肌壁修补术,丙组(30例)行子宫动脉灌注栓塞术联合清宫术,丁组(33例)行腹腔镜下瘢痕妊娠病灶清除术联合子宫肌壁修补术。分析手术时间、住院时间、术中出血量、治疗成功率、术前及术后1d和2dβ-人绒毛膜促性腺激素(β-hGG)、预后指标(阴道流血时间、β-hGG恢复正常时间、瘢痕部位包块消失时间、月经复潮时间及宫腔粘连)及并发症发生情况。结果:治疗成功率甲组最低、手术时间乙组和丁组最长、住院时间甲组和丙组最长、术中出血量甲组和丙组最少(P<0.05);治疗后β-hGG水平4组均下降(P<0.05),但甲组高于其他3组(P<0.05);阴道流血时间甲组和丙组最长、β-hGG恢复正常时间和瘢痕部位包块消失时间均甲组最长、月经复潮时间丙组最长、宫腔粘连比例甲组最低(P<0.05);术后并发症总发生率4组无差异(P>0.05)。结论:腹腔镜下瘢痕妊娠病灶清除术联合子宫肌壁修补术治疗成功率、住院时间、术后1d和2dβ-hGG水平、β-hGG恢复正常时间均优于其他3组,且未增加术后并发症发生。

Objective: To analyze the effects and prognosis of different options for treating pregnant women with cesarean scar pregnancy(CSP). Methods: The clinical data of 102 women with CSP from January 2019 to June 2020 were collected retrospectively. Among them, 20 women in group A were given methotrexate combined with curettage, 29 women in group B were given tranvaginal scar pregnancy removal combined with uterine muscle wall repair, 30 women in group C were given uterine artery perfusion embolization combined with curettage, and 33 women in group D were given laparoscopic scar pregnancy removal combined with uterine muscle wall repair. The operation time, hospital stay, intraoperative blood loss, treatment success rate, the β-human chorionic gonadotropin(β-HCG) level before and on the first and the second day after operation, the prognostic indicators, such as the time of vaginal bleeding, the time of β-HCG level returned to normal, the time of disappearance of scar mass, the time of menstrual recovery, and the rates of adhesion of uterine cavity and the complications of women in the four groups were statistical analyzed. Results: The treatment success rate of the women in group A was the lowest, the operative time of the women in group B and C was the longest, the hospital stay of the women in group A and C was the longest, and the intraoperative blood loss of the women in group A and C was the least(P<0.05). After treatment, the level of β-HCG of the women in the four groups has decreased significantly(P<0.05), but that of the women in group A was significant higher than that of the women in the other three groups(P<0.05). The vaginal bleeding time of the women in group A and C was the longest, the time of β-HCG level returned to normal and the disappearance time of scar mass of the women in group A were the longest, the time of menstruation recovery of the women in group C was the longest, and the proportion of intrauterine adhesion of the women in group A was the lowest(P<0.05).There was no difference in the total incidence of postoperative complications of the women among the four groups(P>0.05).Conclusion:The treatment success rate,the hospitalization time,the β-HCG level on the first and second day after operation,and the time of β-HCG level returned to normal of the pregnant women with CSP treated by laparoscopic scar pregnancy lesion removal combined with uterine muscle wall repair are all significant better than those of the women treated by other methods,and which have not increased postoperative complication occurrence.