224例剖宫产术后子宫疤痕妊娠不同治疗方法的临床疗效分析

发布时间：2018-05-12 18:37

本文选题：子宫疤痕妊娠 + 治疗　；参考：《现代妇产科进展》2016年08期

【摘要】：目的:比较剖宫产术后子宫疤痕妊娠(CSP)不同治疗方法的临床疗效。方法:回顾分析在福建省妇幼保健院妇产科诊治的224例CSP患者,按首治方案分组:药物治疗加清宫术(A组),子宫动脉栓塞(UAE)加清宫术(B组),经腹CSP病灶切除加修补术(C组),腹腔镜下CSP病灶切除加修补术(D组)。根据治疗药物不同将A组再分为:甲氨蝶呤(MTX)(局部/全身)组(A1组),天花粉组(A2组),MTX(局部/全身)加天花粉组(A3),米非司酮组(A4)。根据术前是否行UAE,将C组分为:术前未行UAE(C1组),术前行UAE(C2组)。结果:A、B、C、D组的治疗成功率分别为90.12%、95.61%、100%和100%,差异无统计学意义(P=0.255);入院时血β-HCG、CSP分型、手术出血量、手术时间、住院时间及住院费用比较,差异均有统计学意义(均P0.05)。A1~A4组的治疗成功率分别为85.37%、100%、83.33%、96.43%,差异无统计学意义(P=0.381),入院时血β-HCG、术后2~3天血β-HCG下降程度、手术出血量、手术时间差异无统计学意义(均P0.05),住院时间和住院费用差异有统计学意义(均P=0.000)。C1、C2组的治疗成功率均为100%;入院时血β-HCG、术后2~3天血β-HCG下降程度和住院费用差异有统计学意义(均P0.05);手术出血量、手术时间、住院时间差异无统计学意义(均P0.05)。结论:根据入院时血β-HCG水平、B超情况选择恰当的治疗方案,均能取得好的临床效果。药物治疗采用MTX、或天花粉、或米非司酮临床效果相似,住院时间长,费用增加。UAE后清宫术,可以减少术中出血量。经腹疤痕妊娠病灶切除加子宫修补,术前行UAE未减少术中出血量。
[Abstract]:Objective: to compare the clinical effects of different treatment methods of uterine scar pregnancy (CSP) after cesarean section. Methods: a retrospective analysis was made on 224 cases of CSP in Fujian Maternal and Child Health Care Hospital, who were diagnosed and treated in gynecology and obstetrics. According to the first treatment scheme, group A was divided into two groups: group A, uterine artery embolization (UAE) and uterine embolization (group B), group B, group C, transabdominal CSP lesion resection and repair, laparoscopic CSP lesion resection and repair, and group D, respectively. According to the therapeutic drugs, group A was subdivided into three groups: MTX group (local / systemic), group A 1 (local / systemic), group A 2 (local / systemic) of trichosanthin plus trichosanthin group, group A 4 (mifepristone group). According to the preoperative UAE, group C was divided into three groups: no UAE(C1 before operation, and UAE(C2 before operation. Results the successful rate of treatment was 90.12% and 95.61%, respectively, and there was no significant difference between the two groups (P < 0.255), and the blood 尾 -HCG group CSP classification, operative bleeding volume, operation time, hospitalization time and hospitalization cost were compared on admission. The difference was statistically significant (the success rate of treatment in the P0.05).A1~A4 group was 85.37100 and 83.33, respectively. There was no significant difference between the two groups. The blood 尾 -HCG decreased on admission, and the blood 尾 -HCG decreased 2 days after operation. There was no significant difference in operation time (all P 0.05), but there was significant difference in hospitalization time and hospitalization cost (P < 0. 000). The success rate of treatment in C1C 2 group was 100, and the blood 尾 -HCG decreased at admission, and the decrease of serum 尾 -HCG and hospitalization cost were statistically significant at admission 2 days after operation (P < 0. 05, P < 0. 05, P < 0. 05). Clinical significance (P0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05), There was no significant difference in operation time and hospitalization time (all P 0.05). Conclusion: according to the serum 尾-HCG level at admission and the choice of appropriate treatment regimen by ultrasonography, good clinical results can be achieved. Drug therapy with MTX, trichosanthin, or mifepristone has similar clinical effect, long hospital stay, and increased cost. UAE can reduce the amount of intraoperative bleeding. Abdominal scar pregnancy focus resection and uterine repair, preoperative UAE did not reduce the amount of intraoperative bleeding.
【作者单位】：福建省妇幼保健院妇产科福建医科大学教学医院;福建省连江县医院;福建省尤溪县医院;
【基金】：福建省临床重点专科建设项目资助(No:2012149)
【分类号】：R713.8

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