剖宫产术后子宫疤痕部位妊娠23例的治疗方法及结局分析

目的探讨不同治疗方法对剖宫产术后子宫疤痕部位妊娠(CSP)的治疗结局。方法将23例CSP患者,依据不同治疗方法分为3组:A组(n=12例):MTX+超声监测下清宫术。B组(n=9例):MTX+妊娠病灶清除术。C组(n=2例):子宫切除术。分析比较临床疗效。结果 3组术中出血量、手术后第2天血β-HCG下降百分比及术后随访2 a内再次正常妊娠的例数比较,差异均有统计学意义(P0.05)。结论 CSP确诊后应积极终止妊娠,应选取个体化治疗方法。术前应用MTX可以有效降低血β-HCG水平及减少术中出血量。超声监测下清宫术或病灶切除术是疗效确切的治疗方法,可以保留患者的子宫及生育功能。子宫切除术是急诊大出血或其他治疗方法失败后的最终选择。

Analysis of methods of treatment of 23 cases of uterine scar pregnancy after cesarean section and outcome

Objective To investigate the treatment outcome with different methods of treatment for uterine scar pregnancy after cesare-an section(CSP). Methods A retrospective analysis of 23 patients CSP in our hospital,with three treatment methods:group A(n = 12):MTX + ultrasonography uterine curettage,group B(n = 9):MTX + resection of the pregnancy lesions. ,group C(n = 2):hysterectomy,analy-zing and comparing these 3 methods. Results The average amount of bleeding during the operation in A,B,C groups were:(122 ± 53)mL, (310 ± 27)mL,(1750 ± 750)mL,the difference was of significance in statistic science.(P = 0. 001);the 3 group second days after opera-tion and the blood β - HCG decreased percentages were:(46 ± 2. 5)% ,(57 ± 3. 7)% ,(82 ± 1. 9)% ,there was of significance in statistic science(P < 0. 05);the number of cases of normal pregnancy again within 2 years after operation in the 3 groups were:5,2,0,the difference was of significance in statistic science(P < 0. 05). Conclusion CSP should be pregnancy terminated after diagnosis,treatment should be indi-vidualized,preoperative application of MTX can effectively reduce the serum β - HCG level and reduce the amount of bleeding. Ultrasonic moni-toring curettage or resection of the pregnancy lesions is effective in treatment,which the patients’uterus and fertility function can be reserved, hysterectomy is the ultimate selection of emergency massive haemorrhage or unsuccessful treatment of any other method.