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目的探讨诊断和治疗剖宫产子宫瘢痕妊娠(CSP)的有效方法。方法 34例剖宫产瘢痕妊娠患者,随机分为甲氨蝶呤(MTX)全身化疗组12例(MTX组)及MTX+直接刮宫组(6例),MTX+米非司酮+宫腔镜电切术治疗16例为MTX联合宫腔镜组。观察比较各组疗效。结果入组的34例患者均完成上述治疗,MTX组成功率58.3%,住院时间(24.5±8.3)d;术后血人绒毛膜促性腺激素(β-HCG)恢复正常时间(28.9±15.0)d;直接刮宫组成功率50.0%,手术时间(20.0±7.5)min,术中出血量(316.7±162.5)ml,住院时间(15.5±+5.6)d;术后血β-HCG恢复正常时间(15.5±3.7)d;MTX组联合宫腔镜组,成功率100.0%,手术时间(37.5±12.5)min,术中出血量(45.7±32.5)ml,住院时间(9.5±1.2)d;术后血β-HCG恢复正常时间(10.5±2.7)d;所有患者无一例严重并发症。结论早期超声诊断可以为子宫瘢痕妊娠的治疗提供重要依据,经过MTX+米非司酮治疗后行宫腔镜电切术治疗取得了满意的疗效,优于MTX单药治疗,值得在临床中推广应用。
Objective To explore an effective method for diagnosis and treatment of cesarean scar pregnancy (CSP). Methods 34 patients with cesarean scar pregnancy were randomly divided into methotrexate (MTX) group (12 cases) and MTX + direct curettage group (6 cases), MTX + mifepristone + hysteroscopy Sixteen patients underwent MTX combined with hysteroscopy. Observed and compared the efficacy of each group. Results All of the 34 patients completed the above treatment. The success rate of MTX was 58.3% and the length of hospital stay was (24.5 ± 8.3) days. The postoperative recovery time of serum human chorionic gonadotropin (β-HCG) was (28.9 ± 15.0) d ; The direct curettage power was 50.0%, the operative time was (20.0 ± 7.5) min, the intraoperative blood loss was (316.7 ± 162.5) ml and the hospitalization time was (15.5 ± 5.6) d; the postoperative blood β-HCG recovery time was 3.7) d. MTX combined with hysteroscopy group, the success rate was 100.0%, operation time (37.5 ± 12.5) min, intraoperative blood loss (45.7 ± 32.5) ml, hospital stay (9.5 ± 1.2) -HCG return to normal time (10.5 ± 2.7) d; all patients without a serious complication. Conclusion Early ultrasound diagnosis may provide an important basis for the treatment of uterine scar pregnancy. After MTX + mifepristone treatment, hysteroscopic electrotomy has achieved satisfactory results, which is superior to MTX monotherapy and is worth popularizing in clinic.