剖宫产瘢痕部位妊娠的超声分型与治疗方案选择的比较

发布时间：2018-11-15 18:27

【摘要】：目的探讨剖宫产瘢痕部位妊娠的超声分型以及不同治疗方案的临床结局。方法根据声像图特征,将纳入的瘢痕妊娠分为孕囊富血流型、孕囊乏血流型、包块富血流型和包块乏血流型。每种类型的瘢痕妊娠患者分别接受不同治疗方案。方案A:子宫动脉栓塞术联合甲氨蝶呤治疗;方案B:超声引导下行刮宫术;方案C:甲氨蝶呤全身疗法(肌内注射)。观察治疗成功率、β-HCG恢复至正常的时间、阴道流血量及住院时间。治疗成功指无并发症的发生以及无子宫切除。卡方检验比较同种类型三种治疗方案的治疗成功率是否有显著性差异。方差分析比较同种类型三种治疗方案之间的阴道流血量、β-HCG恢复至正常的时间以及住院时间。结果随访的462例瘢痕部位妊娠,138例孕囊富血流型及142例包块富血流型:方案A的治疗成功率明显高于方案B和方案C,阴道流血量、β-HCG恢复至正常的时间以及住院时间均小于方案B和方案C(P0.05)。109例包块乏血流型及73例孕囊乏血流型:三种方案的治疗疗效无显著性差异(P0.05)。结论子宫动脉栓塞术联合甲氨蝶呤治疗富血流型瘢痕部位妊娠疗效较好。
[Abstract]:Objective to study the ultrasonic classification and clinical outcome of cesarean scar pregnancy. Methods according to the characteristics of sonogram, the scar pregnancy was divided into three types: gestational sac rich blood flow type, pregnant sac lack blood flow type, mass rich blood flow type and inclusion block lack blood flow type. Patients with each type of scar pregnancy received different treatments. Scheme A: uterine artery embolization combined with methotrexate; Scheme B: ultrasound guided curettage; Scheme C: methotrexate systemic therapy (intramuscular injection). The successful rate of treatment, the time of 尾-HCG returning to normal, the amount of vaginal bleeding and the time of hospitalization were observed. Successful treatment refers to the absence of complications and hysterectomy. Chi-square test was used to compare the success rate of the three treatments of the same type. ANOVA was used to compare the vaginal bleeding, the return time of 尾-HCG to normal and the length of hospitalization. Results 462 cases of scar site pregnancy, 138 cases of gestational sac rich blood flow type and 142 cases of mass rich blood flow type were followed-up. The success rate of scheme A was significantly higher than that of scheme B and regimen C, and the amount of vaginal bleeding was significantly higher. The recovery time and hospitalization time of 尾-HCG were less than that of regimen B and C (P0.05). 109 cases of the patients with block lack of blood flow and 73 cases of gestational sac lack of blood flow: there was no significant difference in the therapeutic effects of the three regimens (P0.05). Conclusion uterine artery embolization combined with methotrexate is effective in the treatment of hypervascular scar pregnancy.
【作者单位】：四川大学华西第二医院超声科;四川大学华西第二医院妇科;
【分类号】：R445.1;R714.22

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