剖宫产术后子宫切口瘢痕妊娠不同治疗方法的研究

目的:比较剖宫产术后切口瘢痕妊娠不同治疗方法的有效性。方法:90例切口瘢痕妊娠分为3组:甲氨蝶呤(MTX)组30例、穿刺组30例、介入组30例。用化学发光法检测各组血β-hCG值,B超监测切口瘢痕血流指数,比较各组治疗后血β-hCG、切口瘢痕血流指数、血细胞的变化情况,以及各组的住院时间和转经时间。结果:①介入组血β-hCG下降最快,治疗1周后比原基础值下降80%,而以后则下降缓慢。其次是穿刺组,MTX组血β-hCG下降最慢。②介入组治疗后1～2周,切口瘢痕血流指数明显小于术前。③各组治疗前平均血红蛋白为116.4±8.74g/L、白细胞为6.56±1.99×109/L;治疗后2周平均血红蛋白为113.4±11.6g/L、白细胞为7.35±2.77×109/L,各组血细胞的变化均无明显差异(P>0.05)。④各组住院时间:MTX组38.4±8.4d、穿刺组33.5±4.0d、介入组16.4±7.9d,3组间有显著性差异(P<0.05)。⑤转经时间:MTX组60.0±9.6d、穿刺组50.7±6.5d、介入组36.7±16.7d,3组间有显著性差异(P<0.05)。结论:子宫动脉栓塞术加刮宫术的介入方法明显比单纯MTX或孕囊穿刺术的效果好,缩短了住院时间,月经恢复也较快,子宫动脉栓塞术加刮宫术是目前值得推广应用的技术。

Study on the Different Treatments for Cesarean Scar Pregnancy

Objective：To compare the effectiveness of different treatments for cesarean scar pregnancy.Methods：Ninety cases of cesarean scar pregnancy were randomly divided into 3 groups：MTX group（n=30）,MTX＋gestational sac puncture group（n=30）,and artery embolization group（n=30）.Serum β-hCG,blood flow index in cesarean scar and complete blood count were measured,respectively.Results：1） The sharpest declines of serum β-hCG were found in artery embolization group,followed by puncture group,and the slowest declines in MTX group.2） Blood flow index in cesarean scar was significantly lower than preoperation in the artery embolization group after treatment for 1-2 weeks.3） The average hemoglobin（Hb） level was 116.4±8.7 g/L before treatment,while blood cells（WBC） was 6.56±1.99 ×10^9/L.Two weeks after the treatment,the average Hb was 113.4±11.6 g/L,WBC was 7.35±2.77 ×10^9/L.There was no statistically significant difference among these groups（P〈0.05）.4） The median length of hospital stay in MTX group was 38.4±8.4 d,33.5±4.0 d in pregnant sac puncture group,and 16.4±7.9 d in artery embolization group.There were significant differences among the three groups（P〈0.05）.5）Next menstrual time in MTX group was 60.0±9.6 d,pregnant sac puncture group needed 50.7± 6.5 d,artery embolization group needed 36.7±16.7 d.There were significant differences among the three groups（P〈0.05）.Conclusion：Uterine artery embolization plus curettage surgery is worthy of popularization and application of technology for treatment for cesarean scar pregnancy.