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目的探讨不同方法治疗子宫下段剖宫产术后瘢痕妊娠(CSP)的临床效果,并加以分析。方法回顾性分析57例CSP患者的临床资料。结果 53例患者清宫前使用甲氨蝶呤(MTX)联合米非司酮治疗,45例清宫后3 d内顺利出院,成功率为84.9%;2例因术前B超提示妊娠囊直径>6 cm,子宫下段厚度<2 mm,予行阴式瘢痕妊娠切除术同时行刮宫术,手术过程顺利,术后4 d出院;2例因术前辅助检查提示浆膜层不连续,不排除植入膀胱可能,予术前使用MTX、米非司酮后行开腹手术顺利切除瘢痕妊娠组织。结论治疗CSP的方法有多种,清宫术前使用MTX、米非司酮是治疗瘢痕妊娠的有效方法 ,但需要根据CSP的分型、症状的严重程度等做出合适的选择。
Objective To investigate the clinical effects of different methods in treating post-cesarean scar pregnancy (CSP) of the lower uterine segment and analyze the results. Methods The clinical data of 57 CSP patients were retrospectively analyzed. Results 53 patients were treated with methotrexate (MTX) combined with mifepristone before the curettage and 45 patients were discharged from the hospital within 3 days after the curettage, the success rate was 84.9%. Two patients had gestational sac diameter> 6 cm, the thickness of the lower uterine segment <2 mm, preoperative vaginal scar pregnancy curettage at the same time curettage, the operation was successful, 4 days after discharge; 2 cases due to preoperative auxiliary examination showed serosal discontinuity does not rule out the bladder It is possible to preoperative use of MTX, mifepristone open laparotomy after successful removal of scar pregnancy. Conclusion There are many ways to treat CSP. MTX and mifepristone are the effective methods for the treatment of scar pregnancy. However, the appropriate choice should be made according to the classification of CSP and the severity of symptoms.