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目的观察阴式剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)组织清除术治疗CSP的应用效果,并与子宫动脉栓塞术(uterine artery embolization,UAE)联合刮宫术的临床疗效进行比较。方法回顾性分析2015年7月至2016年10月内江市第二人民医院妇产科收治的158例CSP患者的病历资料,根据不同治疗方式分为观察组77例,对照组81例。观察组患者行阴式CSP组织清除术,对照组患者采取UAE联合刮宫术治疗,比较两组治疗效果、治疗后血清孕酮、孕囊直径等情况。结果观察组手术时间、β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-h CG)恢复正常的时间长于对照组(P<0.05);两组术中出血量、中转开腹率、治疗有效率比较,差异无统计学意义(P>0.05);对照组术后经期延长率、宫腔粘连率高于观察组(P<0.05);通过对患者的生存质量评分发现,观察组患者生理和社会关系方面的评分均高于对照组,差异有统计学意义(P<0.05);观察组经治疗后阴道出血时间、月经恢复时间、患者住院费用和住院时间均少于对照组(P<0.05);术后行超声检查,观察组未发现病灶,而对照组病灶消失时间平均为(24.83±7.16)d。结论阴式CSP组织清除术与UAE联合刮宫术治疗CSP的有效率相当,但手术时间短、β-h CG恢复快,且患者生理及社会关系方面改善更佳,不失为一种有效的外科术式。
Objective To observe the curative effect of cesarean scar pregnancy (CSP) for CSP and to compare the clinical efficacy of uterine artery embolization (UAE) and curettage. Methods The clinical data of 158 CSP patients admitted to Obstetrics and Gynecology Department of Second People’s Hospital of Neijiang from July 2015 to October 2016 were retrospectively analyzed. According to the different treatment methods, 77 cases were divided into observation group and 81 cases in control group. Patients in the observation group underwent vaginal CSP tissue scavenging, and patients in the control group were treated with UAE combined with curettage. The therapeutic effects were compared between the two groups. After treatment, serum progesterone and gestational sac diameters were also compared. Results The operative time of β-human chorionic gonadotropin (β-h CG) in the observation group was longer than that in the control group (P <0.05). The intraoperative blood loss, (P> 0.05). The prolongation rate of postoperative menstruation and intrauterine adhesion rate in the control group were higher than those in the observation group (P <0.05). The quality of life of patients in the observation group The scores of patients in physiology and social relations were higher than those in control group (P <0.05). The vaginal bleeding time, menstruation recovery time, hospitalization cost and hospital stay in observation group were less than those in control group P <0.05). Ultrasound examination showed no lesion in the observation group and disappeared in the control group (24.83 ± 7.16) days. Conclusions The negative CSP is effective in treating CSP with UAE combined with curettage, but the operation time is short, the recovery of β-h CG is quick, and the patients’ physiology and social relations are better. It is an effective surgical technique .