剖宫产瘢痕部位妊娠的超声分型及治疗效果的研究

发布时间：2018-02-01 06:48

  本文关键词： 剖宫产后子宫瘢痕妊娠 超声分型 子宫动脉化疗栓塞术 腹腔镜 阴式手术　出处：《实用妇产科杂志》2017年07期 　论文类型：期刊论文

【摘要】：目的:探讨剖宫产瘢痕部位妊娠(CSP)的超声分型及其对指导临床治疗的意义。方法:回顾性分析成都市第三人民医院2013年1月至2016年1月初诊收治的CSP 41例的临床资料,均根据Godin等提出的CSP B超影像诊断标准,结合剖宫产病史明确诊断。在Vial等的超声分型标准基础上超声测量孕囊处子宫肌层厚度,将其分为Ⅰ型组和Ⅱ型组。Ⅰ型组采用甲氨蝶呤(MTX)肌内注射治疗,3天后B超引导下清宫术;Ⅱ型组采用双侧子宫动脉化疗栓塞术(UACE)后B超引导下清宫术,或UACE后经腹或经腹腔镜或经阴式手术即病灶切除+子宫修补术。结果:Ⅱ型组与Ⅰ型组相比,孕囊处子宫肌层薄(Ⅰ型3.7±0.6 mm vsⅡ型2.1±1.1 mm),人工流产次数多(Ⅰ型1.5±0.6次vsⅡ型2.8±0.7次),差异均有统计学意义(P0.05)。两组年龄、停经天数、剖宫产次数间的比较差异无统计学意义(P0.05)。两组均治疗成功,术中出血、术前血β-HCG水平及术后恢复正常时间比较差异无统计学意义(P0.05)。住院时间(Ⅰ型4.7±2.5天vsⅡ型8.6±2.7天)、费用(Ⅰ型5234.6±1688.8元vsⅡ型15668.4±4623.4元)Ⅱ型组均多于Ⅰ型组,差异均有统计学意义(P0.05)。结论:根据CSP超声分型选择治疗方案针对性强,效果可靠,预后良好。术前应用UACE能有效控制术中出血,是CSP预处理治疗有效手段,因其费用较高,选择性使用于Ⅱ型CSP,性价比高。MTX肌内注射用于Ⅰ型CSP清宫术前,效果可靠,性价比高。
[Abstract]:Objective: To investigate the effect of cesarean scar pregnancy (CSP) type of ultrasound and its significance in guiding clinical treatment. Methods: a retrospective analysis of Third People's Hospital of Chengdu city from January 2013 to early January 2016 from the CSP diagnosis of the clinical data of 41 cases, according to the standard CSP ultrasound imaging diagnosis proposed by Godin et al. Combined with cesarean section in the history of diagnosis. Ultrasound Vial classification based on ultrasonic measurement of gestational sac at the uterine muscle thickness, which can be divided into type I and type II group group. Type I group was treated with methotrexate (MTX) intramuscular injection 3 days after treatment, ultrasound guided curettage; type II group were treated with bilateral uterine artery chemoembolization (UACE) after ultrasound guided curettage, or UACE after transabdominal or transvaginal or laparoscopic surgery excision and repair of the uterus. Results: compared with group II type 1 group, gestational sac myometrium at thin (type I 3.7 + 0.6 mm 2.1 + 1.1 vs type II mm),浜哄伐娴佷骇娆℃暟澶，

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