剖宫产切口部位妊娠的治疗方法探讨

目的：探讨子宫动脉化学治疗栓塞术（uterine artery chemoembolization,UACE）联合清宫术（dilatation and curettage,D＆C）和静脉注射甲氨蝶呤（methotrexate,MTX）联合D＆C2种方法在治疗剖宫产切口部位妊娠（cesarean scar pregnancy,CSP）中的效果及适用情况。方法：回顾分析95例CSP患者的临床资料,其中75例患者采用UACE,术后行超声监护下D＆C（A组）;另20例患者采用MTX静脉用药,术后行超声监护下D＆C（B组）。比较2组患者住院天数、住院费用、术中出血量、胚囊大小变化、胚囊血流阻力指数（resistance index,RI）变化及相关的不良反应。结果：2组患者均取得良好的治疗效果。2组患者在住院天数、D＆C术中出血量方面的差异无统计学意义,但A组住院费用高于B组（P〈0.05）。A组、B组治疗后血β-人绒毛膜性腺激素（β-human chorionic gonadotropin,β-HCG）较治疗前显著降低（P〈0.01）,治疗后B组血β-HCG较A组高（P〈0.05）。治疗前A组胚囊大小显著大于B组（P〈0.01）;A组患者行UACE后RI较治疗前显著升高（P〈0.01）,B组患者行静脉MTX治疗后RI无明显变化。2组患者治疗后胚囊大小治疗前较均有所增大,但差异无统计学意义。A组患者术后发热率为60%。结论：UACE＋D＆C及MTX＋D＆C均能有效治疗CSP,对于胚囊较大者宜采用UACE＋D＆C;对于胚囊较小者可采用MTX＋D＆C,在取得满意疗效的同时可节省医疗费用。

Inquisition of Treatment Methods of Cesarean Scar Pregnancy

Objective：To investigate the efficacy of uterine artery chemoembolization（UACE）combined with dilatation and curettage（DC）and intravenous methotrexate（MTX）injection combined with DC in the treatment of cesarean scar pregnancy（CSP）.Methods：A retrospective study in95 patients with CSP was done.A total of 75 patients received UACE combined with DC（Group A）,and the 20 patients received intravenous MTX injection combined with DC（Group B）.The length of hospital stay,cost,intraoperative blood loss,change of gestational sacs,resistance index（RI）and adverse reactions were recorded.Results：Both treatments were effective.There were no differences in the length of hospital stay and intraoperative blood loss between the two groups.The cost was higher in Group A than that in Group B（P〈0.05）.β-human chorionic gonadotropin（βHCG）levels in both groups after treatment were significantly lower than those before treatment（P〈0.01）.There was significant difference inβ-HCG levels between Group A and Group B after treatment（P〈0.05）.Before treatment,the gestational sac in Group A were larger than those in Group B（P〈0.01）.RI after UACE was much higher than that before treatment in Group A（P〈0.01）.No change of RI was found in Group B.After treatment,the gestational sacs were a little larger than that before treatment in both groups（P〈0.05）.The complication rate of fever was 60%in Group A.Conclusions：Both methods are effective in treating CSP.If the gestational sac is large,the method of UACE＋DC is better;while it is small,the other method should be chosen.