不同方法治疗瘢痕妊娠的临床效果

Clinical efficacy of different methods in the treatment of Cesarean scar pregnancy

目的比较三种方法治疗瘢痕妊娠的临床结局。方法190例瘢痕妊娠患者随机分为三组。A组50例,行超声引导下清宫术;B组70例,采用甲氨蝶呤局部注射联合超声引导下清宫术;C组70例,行子宫动脉栓塞术联合超声引导下清宫术。比较三组基本临床资料、术中出血量、术后血红蛋白下降水平、血人绒毛膜促性腺激素(HCG)转阴时间、住院时间、住院费用和术后并发症发生情况,计算各组治疗成功率。结果A、B、C组治疗成功率分别为96.00%、91.43%、98.57%(P>0.05)。与A组和B组相比,C组术中出血量减少,血HCG转阴时间缩短,但术后并发症发生率增加(P<0.05)。A、B、C组术后血红蛋白下降水平依次减少,住院费用依次增加(P<0.05)。B组住院时间较A组和C组延长(P<0.05)。在Ⅰ型瘢痕妊娠治疗中,B组与A组治疗成功率相仿(P>0.05),但A组术中出血量增加,住院时间和住院费用减少(P<0.05)。在Ⅱ型瘢痕妊娠治疗中,与B组相比,C组治疗成功率和住院费用增加,术中出血量、术后血红蛋白下降水平和住院时间减少(P<0.05)。结论对不同分型的瘢痕妊娠患者,可选择合适的终止妊娠治疗方法,从而提高治疗成功率和安全性。

Objective To compare the clinical outcomes of different methods in the treatment of Cesarean scar pregnancy.Methods A total of 190 patients with Cesarean scar pregnancy were randomly divided into three groups of A(50 cases),B(70 cases)and C(70 cases).The patients in group A accepted ultrasound-guided uterine curettage,which in group B received local injection of methotrexate combined with ultrasound-guided uterine curettage and in group C accepted uterine artery embolization combined with ultrasound-guided uterine curettage.The basic clinical data,intraoperative blood loss,postoperative decreased level of hemoglobin,negative time of human chorionic gonadotropin(HCG),hospital stay,hospitalization expense and complications were compared among the three groups.And the success rate of the treatment in each group was calculated.Results The success rates of the treatment in groups of A,B and C were 96.00%,91.43%and 98.57%,respectively(P>0.05).Compared with groups of A and B,the intraoperative blood loss and negative time of blood HCG were decreased,but the incidence of postoperative complications was increased in group C(P<0.05).The postoperative decreased level of hemoglobin was gradually reduced,while the hospitalization expense was increased in an order of groups of A,B and C(P<0.05).The hospital stay in group B was longer than that in groups of A and C(P<0.05).Compared with group B,the success rate of the treatment was not statistically different(P>0.05),while the intraoperative blood loss was increased(P<0.05),and the hospital stay and hospitalization expense were decreased in group A during the treatment of typeⅠCesarean scar pregnancy(P<0.05).Compared with group B,the success rate of the treatment and hospitalization expense were increased(P<0.05),and the intraoperative blood loss,postoperative decreased level of hemoglobin and hospital stay were decreased in group C during the treatment of typeⅡCesarean scar pregnancy(P<0.05).Conclusion Choosing an appropriate method for terminating the different types of Cesarean scar pregnancy could enhance the success rate and safety of treatment.