224例剖宫产术后子宫疤痕妊娠不同治疗方法的临床疗效分析

目的:比较剖宫产术后子宫疤痕妊娠(CSP)不同治疗方法的临床疗效。方法:回顾分析在福建省妇幼保健院妇产科诊治的224例CSP患者,按首治方案分组:药物治疗加清宫术(A组),子宫动脉栓塞(UAE)加清宫术(B组),经腹CSP病灶切除加修补术(C组),腹腔镜下CSP病灶切除加修补术(D组)。根据治疗药物不同将A组再分为:甲氨蝶呤(MTX)(局部/全身)组(A1组),天花粉组(A2组),MTX(局部/全身)加天花粉组(A3),米非司酮组(A4)。根据术前是否行UAE,将C组分为:术前未行UAE(C1组),术前行UAE(C2组)。结果:A、B、C、D组的治疗成功率分别为90.12%、95.61%、100%和100%,差异无统计学意义(P=0.255);入院时血β-HCG、CSP分型、手术出血量、手术时间、住院时间及住院费用比较,差异均有统计学意义(均P0.05)。A1~A4组的治疗成功率分别为85.37%、100%、83.33%、96.43%,差异无统计学意义(P=0.381),入院时血β-HCG、术后2~3天血β-HCG下降程度、手术出血量、手术时间差异无统计学意义(均P0.05),住院时间和住院费用差异有统计学意义(均P=0.000)。C1、C2组的治疗成功率均为100%;入院时血β-HCG、术后2~3天血β-HCG下降程度和住院费用差异有统计学意义(均P0.05);手术出血量、手术时间、住院时间差异无统计学意义(均P0.05)。结论:根据入院时血β-HCG水平、B超情况选择恰当的治疗方案,均能取得好的临床效果。药物治疗采用MTX、或天花粉、或米非司酮临床效果相似,住院时间长,费用增加。UAE后清宫术,可以减少术中出血量。经腹疤痕妊娠病灶切除加子宫修补,术前行UAE未减少术中出血量。

Efficacy of different treatment of 224 cases of cesarean scar pregnancy

Objective:To investigate the efficiency of different methods in treating pa-tients with cesarean scar pregnancy ( CSP) . Methods:224 CSP patients who received different treatments in Fujian Maternity and Children Health Hospital were retrospectively analyzed. Pa-tients were divided into 4 groups according to method of the treatment:drug therapy followed by dilatation and curettage(Group A);uterine artery embolization (UAE) followed by dilatation and curettage( Group B);CSP abdominal lesion resection combined with repair( Group C);CSP laparoscopic lesion resection combined with repair ( Group D ) . According to different medica-tion,group A was further divided into 4 subgroup:methotrexate ( MTX) ( local/systemic) for treatment(A1),trichosanthin for treatment(A2),methotrexate (MTX) (local/systemic) com-bined with trichosanthin for treatment(A3),mifepristone for treatment (A4). Similarly,goup C was further divided into 2 subgroups:lesion section with UAE preoperatively ( C1 );lesion sec-tion without UAE preoperatively(C2). Results:The rates of therapeutic success in group A、B、C、D were 90. 12%、95. 61%、100%、100% respectively,the difference was not statistically sig-nificant(P=0. 255),although the serum β-HCG level at the hospitalized time,type of CSP, hemorrhage,operative duration,hospital stays,and therapeutic cost,showed statistically signifi-cant difference(P<0. 05 for all),among Group A,B,C and D. Within Group A,there was no statistically significant difference of therapeutic success rate ( 85 . 37%、100%、83 . 33%、96. 43%,respectively,P=0. 381),and the serum β-HCG level at the hospitalized time and its decrease 2~3 days after operation,hemorrhage,operative duration showed no statistically signif-icant difference(P>0. 05 for all),although the hospital stays and therapeutic cost showed statis-tically significant difference(P=0. 000 both),among A1,A2,A3,and A4. The rate of therapeu-tic success in group C1 and C2 was 100% both. Within Group C,the serumβ-HCG level at the hospitalized time and its decrease 2~3 days after operation and therapeutic cost showed statisti-cally significant difference(P<0. 05 for all),although the hemorrhage,operative duration and the hospital stays showed no statistically significant difference ( P>0 . 05 for all ) . Conclusion:Appropriate choice of different method of treatment based on uterine ultrasonography and the se-rum β-HCG level at the hospitalized time all resulted in similarly good clinical outcomes. In drug therapy followed by dilatation and curettage whether it was used of MTX,trichosanthin or mifepristone,the clinical efficiency was similar,the hospital stays was prolonged,and the thera-peutic cost was increased. UAE followed by dilatation and curettage could reduced the operative hemorrhage,but UAE preoperatively could not in CSP abdominal lesion resection combined with repair.