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目的探讨剖宫产瘢痕妊娠(CSP)患者采用宫腔镜手术联合药物治疗的临床效果。方法以2015年3月-2016年3月该院收治的CSP患者104例为研究对象。按照就诊先后顺序分为观察组(甲氨蝶呤+宫腔镜直视下局部电切术)与对照组(甲氨蝶呤+B超定位下负压吸引清宫术)各52例。治疗后随访6个月,对比两组治疗效果。结果观察组患者手术时间、术中出血量、阴道流血时间、月经恢复时间、术后血β-hCG下降至正常时间、住院时间均优于对照组,差异有统计学意义(t=5.217、19.302、8.448、8.417、9.127、27.201,均P<0.05);治疗后6个月,观察组妊娠率80.77%(42/52)高于对照组53.85%(28/52),差异有统计学意义(χ~2=8.57,P<0.05);观察组复发率1.92%(1/52)低于对照组13.46%(7/52),差异有统计学意义(χ~2=4.88,P<0.05);所有患者均未出现相关并发症。结论在CSP患者的临床治疗过程中,采用甲氨蝶呤肌内注射与宫腔镜手术联合治疗的效果显著,能缩短患者手术时间、阴道流血时间、月经恢复时间、术后血β-hCG下降至正常时间、住院时间,减少术中出血量,且能降低复发率,提升妊娠率,值得推广应用。
Objective To investigate the clinical effect of hysteroscopic surgery combined with drug therapy in patients with cesarean scar pregnancy (CSP). Methods From March 2015 to March 2016, 104 CSP patients admitted to our hospital were studied. In accordance with the order of treatment were divided into observation group (methotrexate + hysteroscopy under local electrosurgical resection) and the control group (methotrexate + B-positioning vacuum suction curettage) 52 cases. After 6 months of follow-up, the treatment effect was compared between the two groups. Results The operation time, intraoperative blood loss, vaginal bleeding time, menstruation recovery time, postoperative blood β-hCG decreased to normal time, hospitalization time were better than the control group, the difference was statistically significant (t = 5.217,19.302 , 8.448,8.417,9.127,27.201, all P <0.05). At 6 months after treatment, the pregnancy rate was 80.77% (42/52) in observation group and 53.85% (28/52) in control group, with significant difference (χ ~ 2 = 8.57, P <0.05). The recurrence rate was 1.92% (1/52) in the observation group and 13.46% (7/52) in the control group, the difference was statistically significant (χ ~ 2 = 4.88, All patients had no complications. Conclusions In the clinical treatment of CSP patients, the combination of intramuscular injection of methotrexate and hysteroscopic surgery was significantly effective, can shorten the operation time, vaginal bleeding time, menstruation recovery time, postoperative blood β-hCG decreased To normal time, hospital stay, reduce intraoperative bleeding, and can reduce the recurrence rate, improve pregnancy rate, it is worth promoting the application.