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目的对比分析剖宫产瘢痕部位妊娠(CSP)患者4种治疗方法有效性及优缺点。方法回顾性分析2012年5月-2015年8月该院妇产科收治的CSP患者50例,根据治疗方式分为氨甲蝶呤(MTX)药物治疗后行清宫术组(A组)、B超下清宫手术组(B组)、子宫动脉栓塞组(C组)、经阴道或腹腔镜下病灶切除术组(D组)。比较4种治疗方法的优缺点、治疗疗效和不良反应发生率的差异。结果不同治疗方式患者的治疗疗效和不良反应发生率的差异无统计学意义(χ~2=0.593、3.354,P>0.05);MTX药物治疗后行清宫术组(A组)阴道出血时间最长(18.45±4.79)d以及1周后血β-HCG水平最高(415.36±215.69)m U/L;介入治疗组(C组)的手术时间最短(14.97±5.18)min,术中出血量最少(15.71±5.58)ml;B超下清宫术组(B组)出血量最多(55.39±26.24)ml;病灶切除术组(D组)手术时间最长(35.62±4.41)min,但阴道出血时间最短(7.59±1.65)d以及1周后血β-HCG水平最低(58.25±32.68)m U/L。4组患者手术时间、术中出血量、阴道出血时间及1周后血β-HCG水平比较差异有统计学意义(F=4.875、12.369、5.822、16.927,P<0.05)。结论不同治疗方式的疗效差异无统计学意义,但不同治疗方式在手术时间、术中出血量、血β-HCG水平、阴道出血时间差异有统计学意义,可根据患者的临床特征以及自身意愿选择最佳治疗方案。
Objective To compare and analyze the effectiveness, advantages and disadvantages of four kinds of treatment in patients with cesarean scar pregnancy. Methods A retrospective analysis of 50 cases of CSP patients admitted to obstetrics and gynecology department from May 2012 to August 2015 was divided into group A (group C), group B (group B) and group B (group B) after methotrexate (MTX) Ultrasonography group (group B), uterine artery embolization group (group C), transvaginal or laparoscopic resection group (group D). Compare the advantages and disadvantages of four kinds of treatment methods, the difference between the treatment efficacy and the incidence of adverse reactions. Results There was no significant difference in therapeutic efficacy and incidence of adverse reactions between patients treated with different modalities of treatment (χ ~ 2 = 0.593, 3.354, P> 0.05) (18.45 ± 4.79) d and the highest level of blood β-HCG (415.36 ± 215.69) m U / L after 1 week; the shortest operation time (14.97 ± 5.18) min in intervention group (C group) 15.71 ± 5.58) ml. The bleeding volume in group B (55.39 ± 26.24) ml was the highest (P <0.05). The operation time of the resection group (group D) was the longest (35.62 ± 4.41) min, but the duration of vaginal bleeding was the shortest (7.59 ± 1.65) d and the lowest level of serum β-HCG after one week (58.25 ± 32.68) mU / L. There was significant difference in the blood β-HCG levels between the 4 groups (F = 4.875, 12.369, 5.822, 16.927, P <0.05) after operation, blood loss, vaginal bleeding time and 1 week after operation. Conclusions There is no significant difference in the curative effect of different treatment methods, but there is significant difference in operation time, intraoperative blood loss, blood β-HCG level and vaginal bleeding time between different treatment methods, which can be selected according to the clinical characteristics of patients and their own wishes The best treatment.