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目的探讨瘢痕妊娠的临床类型特点、治疗方式及结局,为不同类型瘢痕妊娠的诊治提供依据。方法选择72例瘢痕妊娠患者为研究对象,回顾性分析所有患者临床特点、治疗方式及结局。结果瘢痕妊娠临床表现无特异性,阴道超声联合核磁共振成像(MRI)可明确瘢痕妊娠的类型;内生型与外生型超声子宫肌层厚度比较,差异有统计学意义(P<0.05);内生型瘢痕妊娠子宫动脉栓塞术联合宫腔镜清宫术(腹腔镜监测下清宫术)治疗的有效率、出血量、二次处理率与药物治疗比较,差异有统计学意义(P<0.05);外生型瘢痕妊娠子宫动脉栓塞术后行腹腔镜病灶切除术治疗的有效率、出血量及二次处理率与药物治疗及宫腔镜治疗比较,差异有统计学意义(P<0.05)。结论术前给予子宫动脉栓塞治疗可以降低瘢痕妊娠大出血的风险,根据不同类型应采取不同的治疗方式,子宫动脉栓塞术后宫腔镜清宫术是治疗内生型瘢痕妊娠一种有效、安全、快速的方式,而栓塞术后腹腔镜病灶切除术是治疗外生型瘢痕妊娠的一种有效、安全、快速的方式。
Objective To investigate the clinical features, treatment and outcome of scar pregnancy and provide evidence for the diagnosis and treatment of different types of scar pregnancy. Methods Seventy-two patients with scar pregnancy were enrolled in this study. The clinical features, treatment modalities and outcomes of all patients were retrospectively analyzed. Results The clinical manifestations of scar pregnancy were nonspecific. Vaginal ultrasound combined with magnetic resonance imaging (MRI) could identify the type of scar pregnancy. The thickness of endometriotic and uterine myometrium was significantly different (P <0.05). Endometrial scar pregnancy uterine artery embolization combined with hysteroscopic curettage (laparoscopic surgery under Qing curettage) treatment efficiency, bleeding, secondary treatment rate and drug treatment, the difference was statistically significant (P <0.05) ; Ectopic scar pregnancy after uterine artery embolization laparoscopic resection of the surgical treatment of the effective rate of bleeding and secondary treatment and drug treatment and hysteroscopic treatment, the difference was statistically significant (P <0.05). Conclusion Preoperative uterine artery embolization can reduce the risk of hypertrophic scar pregnancy, according to different types should take different treatment, hysteroscopic uterine curettage after uterine artery embolization is an effective, safe and rapid method for the treatment of endometrial scar pregnancy Laparoscopic resection after embolization is an effective, safe and rapid way to treat exogenous scar pregnancy.