剖宫产瘢痕部位妊娠的四种治疗方法的临床效果

发布时间：2018-12-07 17:03

【摘要】：目的分析剖宫产瘢痕部位妊娠的(CSP)4种治疗方法有效性及优缺点。方法回顾性分析我科2013年1月~2013年12月共收治的138例CSP患者的病例资料。该138例患者根据其治疗方法分为4组:药物保守(药物组,13例),直接清宫(清宫组,80例),双侧子宫动脉栓塞后清宫手术(栓塞组,40例),剖腹或是经阴式手术行病灶清除术(手术组,5例),比较各组患者治疗过程中出血量、出血量大于50 m L的患者所占比例、住院天数、住院费用。结果其中药物组、清宫组、栓塞组、手术组中患者的出血量中值分别为300、30、50、1500 m L;4组中出血量大于50 m L的患者所占的比例分别为76.9%、38.8%、27.5%、100%;4组住院天数中值为9、4、6、10 d,四组住院费用中值为12821.0、3843.5、14805.0、17202.2。各组以上数据组间比较差异有显著性(P0.05)。结论药物治疗出血多,累计住院时间及住院费用较高,不主张作为治疗首选;直接清宫手术,在CSP治疗方案中住院时间短、花费低,鼓励积极选择。子宫动脉栓塞治疗可以明显降低出血风险,但有一定并发症,且花费较高,慎重选择;手术治疗对于凶险性及孕周较大患者联合子宫动脉栓塞治疗可以增加保留子宫的几率。
[Abstract]:Objective to analyze the effectiveness, advantages and disadvantages of (CSP) in the treatment of cesarean scar pregnancy. Methods the data of 138 cases of CSP admitted from January 2013 to December 2013 were retrospectively analyzed. According to their treatment methods, 138 patients were divided into 4 groups: drug conservative group (drug group, 13 cases), direct uterine clearance group (80 cases), bilateral uterine artery embolization operation (40 cases, embolization group, 40 cases). The patients were treated by laparotomy or transvaginal surgery (operation group, 5 cases). The amount of bleeding, the proportion of patients with bleeding more than 50 mL, the days of hospitalization and the cost of hospitalization were compared. Results the median amount of blood loss in the drug group, Qing Gong group, embolization group and operation group was 38.8% and 27.555%, respectively. The median blood loss in the drug group, the Qing Gong group, the embolization group and the operation group was 300g / 5050ml / L, respectively, and the proportion of the patients with blood loss greater than 50ml / L was 76.9m / L and 38.8m / L, respectively. The median hospitalization days in the four groups were 9 ~ 4 ~ 6 ~ 6 ~ 10 days, and the median hospitalization expenses in the four groups were 12821.0 ~ 3843.5 ~ 14805.0 ~ 17202.2. There was significant difference between the above groups (P0.05). Conclusion Drug therapy has more bleeding, higher cumulative hospitalization time and higher hospitalization cost, and does not advocate as the first choice of treatment. Direct uterine surgery has short hospitalization time and low cost in CSP treatment scheme, and encourages active choice. Uterine artery embolization can significantly reduce the risk of bleeding, but there are certain complications, and high cost, careful choice; surgical treatment for patients with greater risk and gestational weeks combined with uterine artery embolization can increase the probability of uterine retention.
【作者单位】：湖南省妇幼保健院妇一科;
【基金】：湖南省科技厅课题(2014SK3154)
【分类号】：R713.8

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