对剖宫产后疤痕部位妊娠保守治疗的探讨

目的对剖宫产术后子宫疤痕妊娠保守治疗的方法行疗效比较，从而选择一种有效治疗方案。方法B超确诊子宫疤痕部位妊娠38例，分3组治疗。Ⅰ组：MTX肌注15例；Ⅱ组：天花粉肌注8例；Ⅲ组：MTX肌注一周后行孕囊穿刺15例。根据用药后第2N血清β-HCGT降的百分率、阴道出血量、住院时间比较3组疗效。结果在用药2N后．3组血清β-HCG均显著下降。但Ⅲ组的血清B—HCGT降百分率显著高于Ⅰ组和Ⅱ组（P〈0．01），同时Ⅲ组阴道出血量和住院时间均低于Ⅰ组和Ⅱ组（P〈0．05，P〈0．01）。结论应用MTX3L注后加孕囊穿刺治疗子宫疤痕妊娠可能更为有效、安全。

A study of conservative treatments for embryo implantation at cesarean section scar

Objective In order to find an effective method for treating embryo implantation at cesarean section scars, the curative effect of three conservative treatments were compared. Methods Thirty eight cases of early pregnancy implanted in previous cesarean section scar were diagnosed by ultrasound. Patients were divided into three groups for the treatment. GroupⅠ treated with methoerexate （MTX） by intramuscular injection （n =15）. Group Ⅱ treated with crystalline trichhosantin maxm by intramuscular injection （n=8）. Group Ⅲ treated with transvaginal needle aspiration of gestational sac after MTX intramuscular injection one week later（n=15）. Results The levels of β-HCG in sera were significantly dropped after two weeks of treatment. The reduced percentile of IS-HCG in group Ⅲ was significant graeter than the other two groups. The amount of bleeding and the number of hospital days in group Ⅲ were also significant less than the other two groups. （P〈0.05, P〈0.01）. Conclusion The MTX by intramuscular injection plus aspiration of gestational sac will be safer and more effective methods for treatment of early pregnancy of cesarean section scar.