Ⅰ型剖宫产术后子宫瘢痕部位妊娠的临床分析

TypeⅠcesarean scar pregnancy:a clinical analysis

目的探讨Ⅰ型剖宫产术后子宫瘢痕妊娠(CSP)的早期诊断、临床特点及诊疗方案和转归。方法回顾性分析2018年1月至2020年7月收治的18例Ⅰ型CSP患者。分析其临床数据、诊疗方案及结果。结果治疗结局:采用基于超声分型的手术治疗均成功,所有患者术后1 d血β-HCG均降至术前的<50%,18例患者术后3个月超声检查均未发现子宫前壁下段异常回声表现;甲氨蝶呤(MTX)联合米非司酮清宫组(A组)与米索前列醇清宫组(B组),术中出血[(17.27±7.80)ml与(75.00±90.94)ml]、住院时间[(4.00±1.54)d与(6.73±1.79)d]比较,差异均有统计学意义(P<0.05)。手术时间[(11.92±3.84)min与(13.42±2.84)min]及术后HCG降至正常时间[(21.00±5.42)d与(22.17±5.27)d]比较,差异均无统计学意义(P>0.05)。A组治疗总有效率100.00%(12/12)与B组的100%(6/6)比较,差异无统计学意义(P>0.05)。A组满意度83.33%(10/12)与B组的83.33%(5/6)比较,差异无统计学意义(P>0.05)。结论超声分型检查为临床诊疗方案选择提供了重要依据,在超声引导下两种治疗方式均可用于Ⅰ型剖宫产瘢痕部位妊娠患者治疗;清宫术后应用Foley导尿管,能够有效止血,减少术后阴道出血,提高了安全性。

Objective To explore the early diagnosis,clinical characteristics,therapeutic schemes,and disease outcome of type I cesarean scar pregnancy(CSP-Ⅰ).Methods The patients with CSP-Ⅰ(n=18)who were admitted to The Third Hospital of Hebei Medical University(January 2018 to July 2020)were retrospectively enrolled,the clinical data,therapeutic schemes and disease outcome were assess.Results Treatment outcome:based on ultrasound classification,all surgical treatment was successful;the 1-day beta-human chorionic gonadotropin(β-HCG)levels fell to less 50%of preoperative;the 3-month ultrasonography of all patients showed no abnormal echo in lower anterior uterine wall.The difference was statistically significant in the intraoperative bleeding([17.27±7.80]ml vs[75.00±90.94]ml)and hospital days([4.00±1.54]d vs[6.73±1.79]d)between Group A(methotrexate[MTX]+mifepristone[MIF])and Group B(oral misoprostol tablets)(P<0.05).There was no significant difference being found in the operation time([11.92±3.84]min vs[13.42±2.84]min)and time for postoperative HCG normalization([21.00±5.42]d vs[22.17±5.27]d)between Group A and Group B(P>0.05).No difference in overall effective rate were significant between Group A and Group B(100%[12/12]vs 100%[6/6],[P>0.05]respectively).The satisfaction difference was not statistically significant in the between Group A and Group B(83.33%[10/12]vs 83.33%[5/6],[P>0.05],respectively).Conclusion The ultrasound classification plays a significant role in selection of therapeutic schemes.The both ultrasound-guidance therapeutic schemes are suitable for for patients with t-CSP-Ⅰ;Postoperative Foley catheter can effectively stop bleeding,reduce postoperative vaginal bleeding,and which is safety.