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目的:探讨剖宫产术后子宫瘢痕部妊娠(CSP)的诊断及治疗方法。方法:选取2012~2013年吉林大学第二医院收治的CSP患者35例,根据治疗方法分为3组,药物预处理+宫腔镜下胚物组织清除术组(A组,20例)、子宫动脉栓塞+宫腔镜下胚物组织清除术组(B组,13例)和子宫切除组(C组,2例)。分析3组治疗效果及不良反应发生情况。结果:A组成功18例,其余2例转入B组进行治疗;B组和C组均全部获得成功,3组成功率比较,差异无统计学意义(P>0.05)。3组患者β-hCG恢复至正常时间、阴道流血时间、住院时间、住院费用比较,差异有统计学意义(P<0.05)。结论:患者临床症状、既往剖宫产史、停经史及实验室辅助检查结果可早期诊断剖宫产术后CSP,根据患者情况选择个体化治疗方案,可获得满意预后,值得临床推广应用。
Objective: To investigate the diagnosis and treatment of uterine scar pregnancy (CSP) after cesarean section. Methods: Thirty-five CSP patients admitted to the Second Hospital of Jilin University from 2012 to 2013 were divided into three groups according to the treatment methods: drug pretreatment + hysteroscopic excisional biopsy (group A, n = 20) Arterial embolization + hysteroscopic embryo excision (group B, 13 cases) and hysterectomy group (group C, 2 cases). Analysis of 3 groups of treatment and adverse reactions occurred. Results: 18 cases were successful in group A, and the other 2 cases were transferred to group B for treatment. All the patients in group B and C were successful. There was no significant difference in success rate between the three groups (P> 0.05). The difference of β-hCG between normal control group, vaginal bleeding time, hospitalization time and hospitalization cost was statistically significant (P <0.05). Conclusion: The clinical symptoms, past history of cesarean section, history of menopause and laboratory test results can be used to diagnose CSP after cesarean section. According to the patient’s condition, individualized treatment plan can be selected to obtain satisfactory prognosis, which is worthy of clinical application.