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目的评价CT检查在剖宫产疤痕部位妊娠(CSP)诊疗中的价值。方法回顾性分析36例CSP的CT表现及其治疗方案,将根据CT评估制定治疗方案的病例归为一组(评估组,n=26),将根据临床经验制定治疗方案的病例归为对照组(n=10),采用精确概率法比较两组病例治疗过程中的大出血发生率。结果评估组26例中,CT诊断为植入型CSP 16例、单纯型CSP 10例。根据CT建议,植入型采用与介入相结合的综合治疗,单纯型采用局部注射甲氨蝶呤(MTX)结合超声引导下清宫术治疗,所有病例预后良好,无大出血病例。对照组10例,CT诊断均为植入型CSP,根据临床经验采用局部注射MTX结合超声引导下清宫术治疗,其中5例发生大出血。评估组大出血发生率明显小于对照组,有显著差异(P=0.001)。结论 CT检查不仅是诊断CSP有效手段,而且对于临床治疗方案的制定有着重要的指导价值,可以大大降低CSP治疗过程中的大出血发生率。
Objective To evaluate the value of CT in the diagnosis and treatment of pregnancy with cesarean scar (CSP). Methods A retrospective analysis of 36 cases of CSP CT performance and treatment options, based on CT assessment of the treatment plan were grouped into a group (assessment group, n = 26), based on clinical experience in the development of treatment programs were classified as control group (n = 10). The exact probability method was used to compare the incidence of major bleeding in the two groups during treatment. Results In the 26 patients in the evaluation group, CT was diagnosed as 16 cases of implanted CSP and 10 cases of simple CSP. According to the CT recommendations, the implantable type was combined with the interventional treatment. The simple type was treated with MTX combined with ultrasound guided curettage. All patients had a good prognosis and no major bleeding. Control group of 10 cases, CT diagnosis of implantable CSP, according to clinical experience with local injection of MTX combined with ultrasound-guided curettage, including 5 cases of hemorrhage. The incidence of major bleeding in the assessment group was significantly lower than that in the control group (P = 0.001). Conclusion CT examination is not only an effective method for the diagnosis of CSP, but also has an important guiding value for the development of clinical treatment programs, which can greatly reduce the incidence of major bleeding in CSP treatment.