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目的:对比剖宫产术后子宫切口瘢痕妊娠(CSP)的不同治疗方法的有效性。方法:选取2009年3月~2013年3月该院收治的确诊CSP患者216例,按照治疗方案分为先行子宫动脉栓塞后行超声引导下清宫术(A组)92例、MTX联合孕囊穿刺(B组)64例、腹行病灶切除术(C组)60例。对比三组患者治疗后血β-HCG、血流指数、血细胞的变化情况等指标。结果:A组患者血β-HCG下降最快,其次是B组,C组下降最慢;A组治疗后1~2周,血流指数较术前显著降低,差异有统计学意义(P<0.01);各组治疗后血红蛋白和白细胞水平较治疗前差异无统计学意义(P>0.05);三组患者住院和转经时间差异有统计学意义(P<0.05),C组患者住院时间和转经时间最长,A组患者最短。结论:先行子宫动脉栓塞后行超声引导下清宫术治疗效果显著优于MTX联合孕囊穿刺和腹行病灶切除术,值得在临床推广应用。
PURPOSE: To compare the effectiveness of different treatments for cesarean scar pregnancy (CSP) after cesarean section. Methods: A total of 216 patients with confirmed CSP admitted to our hospital from March 2009 to March 2013 were selected and divided into two groups according to the treatment regimen: uterine artery embolization (92 cases), ultrasound-guided radical hysteroscopy (group A), MTX combined with gestational sac puncture (Group B) 64 cases, abdominal line excision (group C) 60 cases. Comparing the three groups of patients with blood β-HCG, blood flow index, changes in blood cells and other indicators. Results: The decrease of β-HCG in group A was the fastest, followed by group B, the slowest in group C. The index of blood flow in group A was significantly lower than that before operation (P < 0.01). There was no significant difference in hemoglobin and leukocyte level between the two groups after treatment (P> 0.05). There was significant difference between the three groups in the duration of hospitalization and menstrual cycle (P <0.05) The longest transfer time, the shortest in group A patients. Conclusion: Uterine artery embolization after ultrasound-guided curettage is significantly better than MTX combined with gestational sac puncture and abdominal line resection, it is worth in the clinical application.