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目的探讨剖宫产瘢痕妊娠(CSP)不同临床分型应用三种方法治疗的有效性和安全性。方法回顾性分析2008年1月—2016年6月该院收治的剖宫产瘢痕妊娠52例,根据治疗方法分成三组,吸宫术组、剖宫产瘢痕妊娠病灶切除术组和甲氨蝶呤(MTX)药物治疗组,总结三组中CSP的不同分型以及CSP不同临床分型治疗效果和愈后。结果吸宫术组29例手术均成功,CSP临床分型Ⅰ型27例,Ⅱ型2例,平均住院日4d,平均出血量50ml,平均术后出血时间15d,平均术后β-HCG恢复正常时间20d,局部包块吸收时间1~3个月。剖宫产瘢痕妊娠病灶切除术组9例均成功,CSP临床分型均为Ⅲ型,平均住院日7d,平均出血量100ml。术后无淋漓出血。MTX药物治疗组14例,4例Ⅰ型瘢痕妊娠,用MTX后复查β-HCG升高改行吸宫术,1例Ⅲ型瘢痕妊娠用MTX后阴道大量出血改行瘢痕妊娠病灶切除术,6例Ⅱ型瘢痕妊娠β-HCG下降后行宫腔镜下病灶切除术,另3例Ⅱ型瘢痕妊娠β-HCG下降后胎囊自行排出。平均住院天数12d。结论临床治疗中应该根据CSP不同的临床分型采取适宜治疗方式。对于Ⅰ型CSP直接清宫术是最经济的治疗方法,Ⅲ型CSP妊娠病灶切除术是最安全的治疗方法,种植深度介于二者之间的Ⅱ型CSP适宜采取MTX药物治疗。
Objective To investigate the effectiveness and safety of three methods of cesarean scar pregnancy (CSP) in different clinical types. Methods 52 cases of cesarean scar pregnancy treated in our hospital from January 2008 to June 2016 were retrospectively analyzed. According to the method of treatment, the patients were divided into three groups. The patients in the ejaculation group, cesarean scar pregnancy group and methotrexate (MTX) drug treatment group, summarizes the different types of CSP in three groups and CSP different clinical classification of the treatment effect and prognosis. Results In the group of smoking aspiration, all the 29 cases were successfully operated. The clinical classification of CSP was type Ⅰ in 27 cases and type Ⅱ in 2 cases. The average length of hospitalization was 4 days. The mean amount of bleeding was 50 ml. The average postoperative bleeding time was 15 days. Time 20d, local mass absorption time of 1 to 3 months. Cesarean scar pregnancy, resection group, 9 cases were successful, CSP clinical type were type Ⅲ, the average hospitalization day 7d, the average amount of bleeding 100ml. No bleeding after surgery. MTX drug treatment group, 14 cases, 4 cases of type Ⅰ scar pregnancy, with MTX after the review of β-HCG elevated reshuffle, 1 case of type Ⅲ scar pregnancy with MTX vaginal massive hemorrhage diverted scar pregnancy resection, 6 cases of Ⅱ Type scar pregnancy β-HCG decreased hysteroscopic resection, and the other 3 cases of type Ⅱ scar pregnancy β-HCG decreased after discharge of the fetal sac. The average length of stay 12d. Conclusion Clinical treatment should be based on the different clinical classification of CSP to take appropriate treatment. For type C CSP direct cesarean section is the most economical treatment, CSP pregnancy cesarean section excision is the safest treatment, the depth of planting between the two type CSP is appropriate to take MTX drug treatment.