剖宫产瘢痕部位妊娠的两种治疗方法比较

Comparison of therapeutic effects of two treatments for cesarean section scar pregnancy

  • 摘要: 目的 通过分析总结剖宫产术后子宫瘢痕部位妊娠(cesarean scar pregnancy,CSP)病例资料,比较CSP分型及其两种治疗方法的临床特点。 方法 选取我院2012年6月- 2015年6月诊治的剖宫产瘢痕部位妊娠患者共67例,分为观察组采用宫腔内注射氨甲蝶呤(methotrexate,MTX)联合清宫术治疗和对照组(采用子宫动脉栓塞联合清宫术治疗),比较两组一般资料及疗效。 结果 观察组35例,对照组32例,两组平均年龄、孕周、孕囊大小以及临床分型差异无统计学意义。MTX联合清宫术组(观察组)阴道流血时间(21.7±7.0)d vs (28.5±9.8) d)少于子宫动脉栓塞联合清宫术组(对照组)(P=0.002);月经恢复时间(54.9±6.3) d vs (47.7±6.6) d长于对照组(P< 0.001)。两组绒毛膜促性腺激素恢复正常时间(28.4±11.3) d vs (26.5±10.4) d和治疗成功率32例(91.4%) vs 28例(87.5%)差异无统计学意义(P> 0.05)。 结论 采用宫腔内注射MTX联合清宫术治疗CSP,操作难度低,临床疗效肯定,花费少,值得基层医院推广使用。

     

    Abstract: Objective To compare the clinical features of two treatment methods through analysis and summary of clinical data about patients with uterine scar pregnancy after cesarean section. Methods There were 67 patients with pregnancy of cesarean scar from June 2012 to June 2015 in our hospital, and they were divided into observation group (intrauterine injection of MTX combined with curettage treatment) and control group (uterine artery embolization combined with curettage treatment). The general data and therapeutic effect of the two groups were compared. Results There were 35 cases in the observation group and 32 cases in the control group. The differences in average age, gestational age, gestational sac size and clinical classification between the two groups were not statistically significant. In the observation group, the vaginal bleeding time was less than that of the control group (21.7±7.0) d vs (28.5±9.8) d, P=0.002, while the recovery time was more than that of the control group (54.9±6.3) d vs (47.7±6.6) d, P< 0.001. There was no significant difference in the recovery time of β-hCG (28.4±11.3) d vs (26.5±10.4) d and treatment success rate 32 cases (91.4%) vs 28 cases (87.5%) between two groups. Conclusion The intrauterine injection of MTX combined with curettage treatment for CSP is effective, ecomomic and convenient, which can be applied in primary hospitals.

     

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