论文部分内容阅读
目的:探讨不同类型剖宫产瘢痕妊娠(CSP)的治疗方法。方法:选择经临床确诊为CSP的患者60例,根据CSP的类型分为内生型组(Ⅰ组)19例和外生型组(Ⅱ组)41例,每组再根据不同治疗方法各分为两个亚组,Ⅰ组包括:ⅠA组应用甲氨喋呤(MTX,Methotrexate)后超声引导下清宫术(7例);ⅠB组应用MTX及双侧子宫动脉灌注化疗栓塞术(UACE,Uterine aytery embolization chemotherapy)后超声引导下清宫术(12例)。Ⅱ组包括:ⅡA组行超声引导下清宫术+/-MTX(11例);ⅡB组应用MTX+UACE+超声引导下清宫术(30例)。以妊囊大小、术中出血量、人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)恢复正常时间、首次治愈率、二次治愈率、住院时间、住院费用及月经恢复正常时间、术后妊娠率作为疗效评估参数比较两组中亚组间相关数据的差异。结果:Ⅰ组中,两亚组妊囊大小、术中出血量、住院天数、血HCG及月经恢复时间、首次治愈率比较差异无统计学意义(P>0.05);ⅠA组住院花费明显少于ⅠB组(P<0.05)。Ⅱ组中,两亚组住院天数、住院费用及妊囊大小比较差异无统计学意义(P>0.05);ⅡA组术中出血量及月经恢复时间明显多于ⅡB组,血HCG下降率及首次治愈率明显低于ⅡB组(P<0.05)。结论:CSP可根据类型选用合适的治疗方法。内生型适用于MTX+超声引导下清宫术,而外生型适用于MTX+UACE+超声引导下清宫术。
Objective: To explore the treatment of different types of cesarean scar pregnancy (CSP). Methods: Sixty patients with clinically diagnosed CSP were divided into two groups according to the type of CSP: 19 cases of endometriosis group (group Ⅰ) and 41 cases of exogenous group (group Ⅱ), each group was divided according to different treatment methods Group Ⅰ consisted of ⅠA group (7 cases) undergoing ultrasound guided methotrexate (MTX) and MTX group and bilateral uterine arterial chemoembolization group (UACE) aytery embolization chemotherapy) under the guidance of ultrasound curettage (12 cases). Ⅱ group included: group ⅡA under the guidance of ultrasound-guided radical hysteroscopy / MTX (11 cases); group ⅡB under MTX + UACE + ultrasound-guided radical hysteroscopic surgery (30 cases). In order to restore the normal time, the first cure rate, the second cure rate, the length of hospitalization, the cost of hospitalization and the normal period of menstrual recovery, the size of the pregnant sac, intraoperative blood loss, intraoperative blood loss and β-human chorionic gonadotropin (β-HCG) , Postoperative pregnancy rate as a parameter to evaluate the efficacy of the two subgroups compared between the subgroup data differences. Results: In Ⅰ group, there was no significant difference in the first cure rate between the two groups in terms of the size of pregnant sac, amount of blood loss during operation, hospital stay, blood HCG and menstruation recovery time (P> 0.05) Ⅰ B group (P <0.05). In group Ⅱ, there was no significant difference in the length of hospital stay, hospitalization cost and the size of pregnant pregnancy between the two sub-groups (P> 0.05). The intraoperative blood loss and menstruation recovery time of ⅡA group were significantly more than that of ⅡB group The cure rate was significantly lower than that of group ⅡB (P <0.05). Conclusion: CSP can choose the appropriate treatment according to the type. Endogenous for MTX + ultrasound guided curettage, and exogenous for MTX + UACE + ultrasound-guided curettage.