上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (11): 1621-.doi: 10.3969/j.issn.1674-8115.2011.11.025

• 论著（临床研究） • 上一篇    下一篇

剖宫产术后瘢痕妊娠不同治疗方法的疗效分析

朱俊彦, 狄 文   

  1. 上海交通大学 医学院附属仁济医院妇产科, 上海 200127
  • 出版日期:2011-11-28 发布日期:2011-11-29
  • 通讯作者: 狄 文, 电子信箱: diwen163@163.com。
  • 作者简介:朱俊彦（1981—）, 女, 住院医师, 硕士；电子信箱: amendazhuzhu@163.com。
  • 基金资助:

    上海市教委第五期重点学科

Outcomes of different treatment methods for cesarean scar pregnancy

ZHU Jun-yan, DI Wen   

  1. Department of Obstetrics and Gynaecology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2011-11-28 Published:2011-11-29
  • Supported by:

    Shanghai Education Committee Foundation

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摘要：

目的 分析剖宫产术后瘢痕妊娠的治疗方法的疗效。方法 45例剖宫产术后瘢痕妊娠患者，根据治疗方法的不同分为三组。①甲氨蝶呤（MTX）组（n=6）：全身使用MTX； ②刮宫术组（n=17）：行刮宫术治疗。③子宫动脉栓塞（UAE）组（n=22）：行UAE联合局部注射MTX及刮宫术治疗。比较各组治疗效果。结果 MTX组、刮宫术组和UAE组的治疗成功率分别为50%（3/6）、64.71%(11/17)和100%(22/22)，三组治疗成功率比较差异有统计学意义（P<0.05）。UAE组术中出血量明显少于刮宫术组（P<0.05）。三组患者的年龄、剖宫产次数、孕龄、孕囊大小和初始血β人绒毛膜促性腺激素（β-HCG）水平比较，差异均无统计学意义(P>0.05)。三组患者住院时间、血β-HCG恢复正常时间和宫内包块消失时间比较，差异有统计学意义（P<0.05）。UAE组患者住院时间和宫内包块消失时间短于MTX组和刮宫术组(P<0.05)；刮宫术组血β-HCG恢复正常时间短于MTX组和UAE组(P<0.05)。UAE组中，22.73%(5/22)的患者术后体温超过38 ℃，9.09%(2/22)的患者术后出现下腹痛。结论 子宫动脉栓塞联合治疗是剖宫产术后瘢痕妊娠安全、有效的治疗方法。

关键词: 剖宫产, 瘢痕妊娠, 甲氨蝶呤, 刮宫术, 子宫动脉栓塞

Abstract:

Objective To analye the outcomes of the treatment methods for cesarean scar pregnancy. Methods Forty-five women with cesarean scar pregnancy were divided into three groups according to different treatment methods. Methotrexate (MTX) was systemically applied in MTX group (n=6), dilation and curettage were performed in dilation and curettage group (n=17), and women in uterine artery embolisation (UAE) group (n=22) underwent uterine artery embolisation in combination of local injection of MTX and dilation and curettage. The outcomes were compared among groups. Results There were significant differences in success rates among MTX group (50%, 3/6), dilation and curettage group (64.71%, 11/17) and UAE group (100%, 22/22)(P＜0.05). The volume of blood loss during operation in UAE group was significantly smaller than that in dilation and curettage group (P＜0.05). There was no significant difference in age, number of cesarean section, gestational age, size of sac and initial level of human chorionic gonadotropin (β-HCG) among three groups (P＞0.05). There were significant differences in duration of hospital stay, time for β-HCG recovery and time for mass disappearance among three groups (P＜0.05). The duration of hospital stay and time for mass disappearance in UAE group were shorter than those in MTX group and dilation and curettage group (P＜0.05). The time for β-HCG recovery in dilation and curettage group was shorter than that in MTX group and UAE group (P＜0.05). In UAE group, 22.73% cases (5/22) had body temperature higher than 38 ℃, and 9.09% cases (2/22) experienced pelvic pain. Conclusion UAE is an effective and safe treatment method for cesarean scar pregnancy.

Key words: cesarean section, cesarean scar pregnancy, methotrexate, dilatation and curettage, uterine artery embolisation