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目的探讨剖宫产术后子宫瘢痕妊娠不同治疗方案的选择。方法回顾性分析2012年2月~2014年4月吉林大学第二医院、青岛市妇女儿童医院及长春市妇产医院确诊收治的106例子宫瘢痕妊娠患者。结合患者情况选用个体化治疗方案进行治疗。按治疗方法将患者分为4组:A组(47例)给予药物预处理+宫腔镜下治疗,B组(32例)给予双侧子宫动脉化疗栓塞介入+宫腔镜下治疗,C组(16例)给予开腹手术,D组(11例)给予阴式子宫瘢痕妊娠切除术治疗。分析各组的治疗效果、术中情况、住院时间及住院费用。结果 4组患者初始血绒毛膜促性腺激素(β-h CG)水平、手术时间、术中出血量、住院时间及住院费用比较差异有统计学意义(P<0.05)。其他各项指标比较,差异无统计学意义(P>0.05)。结论 4种方法均有较高的治愈率。应通过比较瘢痕妊娠的时间,胚胎成活情况,病灶大小、外凸或内凸,有无妇科合并症,是否需要保留子宫等因素来综合考虑,从而选择符合患者自身特点的最佳治疗方案。
Objective To explore the choice of different treatment options for uterine scar pregnancy after cesarean section. Methods A retrospective analysis of 106 cases of uterine scar pregnancy diagnosed in the Second Hospital of Jilin University, Qingdao Women and Children Hospital and Changchun Maternity Hospital from February 2012 to April 2014 was retrospectively analyzed. Combined with the patient’s condition, choose individual treatment plan for treatment. The patients were divided into 4 groups according to the treatment methods: Group A (47 cases) received pretreatment of medicine and hysteroscopic treatment, Group B (32 cases) received bilateral uterine arterial chemoembolization and hysteroscopic treatment, Group C (16 cases) were given laparotomy. Group D (11 cases) were given vaginal uterine scar pregnancy excision. Analysis of the treatment effect of each group, intraoperative, hospitalization and hospitalization costs. Results The initial blood levels of chorionic gonadotropin (β-h CG), operation time, intraoperative blood loss, hospital stay and hospitalization costs were significantly different among the four groups (P <0.05). Other indicators, the difference was not statistically significant (P> 0.05). Conclusion All four methods have higher cure rate. Should be by comparing the time of scar pregnancy, embryo survival, size of the lesion, convex or convex, with or without gynecological complications, whether the need to retain the uterus and other factors to consider, to choose the best treatment in line with the patient’s own characteristics.