子宫下段剖宫产瘢痕妊娠处理的临床分析

摘要

目的:探讨子宫下段剖宫产瘢痕妊娠(CSP)患者处理的相关因素.方法:将同期诊治的24例患者(1例行瘢痕妊娠病灶切除术除外)分成两组,传统治疗组11例,给予甲氨蝶呤(MTX)、米非司酮药物保守治疗;双侧子宫动脉栓塞术(UAE)+MTX组12例,给予UAE及MTX灌注治疗.两者治疗后均在B超引导下或宫腔镜下行清宫术.监测两组患者β-HCG下降水平、阴道出血量、再次清宫术等情况.结果:1周后β-HCG下降幅度比较,传统治疗组下降50%～60%,UAE+MTX组下降60%～85%.血流比值及血流RI比较,传统治疗组与UAE+MTX组治疗后均大于治疗前;治疗后UAE+MTX组大于传统治疗组,差异均有高度统计学意义(均P<0.01).阴道出血量比较,传统治疗组4例>200 ml、4例<100 ml、3例介于两者之间;UAE+ MTX组均<100 ml.再次清宫术,传统治疗组3例;UAE+MTX组均无需行再次清宫术.住院时间比较,传统治疗组平均为11.5 d,UAE+ MTX组平均为8 d.结论:UAE+MTX可迅速杀胚、止血,术后在B超引导或宫腔镜下行清宫术可彻底清除病灶,安全有效,阴道出血量少,无需再次清宫术,避免子宫切除,创伤小,值得临床推广.%Objective: To investigate the related factors of trealment in lower uterine segment caesarean scar pregnancy (CSP). Methods: In the same period, 1 patient of CSP were received the resection of scarred pregnancy, 23 CSP were divided into two groups. Traditional treatment group (11 cases) was treated with MTX and Mifepristone, UAE+MTX group (12 cases) was treated with bilateral uLerine artery embolization (UAE) and injected MTX. After trealment,the two groups were given curettage under B-guided or hysteroscopy. β-HCG reduced levels. Blood-flow conditions and vaginal bleeding of the two groups were monitored. Results: β-HCG reduced levels affer 1 week of the two groups were compared, traditional treatment group was 50％-60％ and UAE+MTX group was 60％-85％. Perfusion ratio and blood RI of the two groups were compared, after treatment the values of the two groups were higher than that before treatment, and after treatment the values of UAE+MTX group were higher than traditional treatment group, and there were significant differences between them (all P＜0.01). Volumes of vaginal bleeding of the traditional treatment group: ＞200 ml in 4 cases,＜100 ml in 4 cases and 3 cases among of them. Volumes of vaginal bleeding of UAE+MTX group were all ＜100 ml. 3 cases in traditional treatment group needed re-curettage, but none of UAE+MTX group needed re-curettage. Mean hospital stay time of traditional treatment group was 11.5 d and UAE+MTX group was 8 d. Conclusion: UAE+MTX can kill embryo and stop bleeding rapidly,after curettage under B-guided or hysteroscopy, it is more safe and effective, less vaginal bleeding and decrease the incidence of re-curettage, slight trauma, which is worthy of exploration and clinical promotion.