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目的:分析不同方式初始治疗子宫切口瘢痕妊娠的临床效果。方法:收集2009年3月~2013年8月间于该院确诊的瘢痕妊娠(CSP)患者272例,按治疗方式不同分为四组:A组,先行双侧子宫动脉介入造影栓塞术(UAE)后行超声引导下清宫术140例(包括因大出血入院10例);B组,直接行超声引导下清宫术54例;C组,甲氨蝶呤(MTX)孕囊腔内注射后行超声引导下清宫术51例;D组,经腹行病灶切除术27例;各组患者依据其超声图像表现分为内生型与外生型。比较各组患者入院血β-HCG值、初始治疗成功率、术中出血量、住院时间。结果:A、B、C、D四组入院时血β-HCG值差异无统计学意义,所有内生型与外生型患者血β-HCG值差异无统计学意义,A组内生型与外生型出血量及住院时间、成功率差异无统计学意义,A组无论内生型、外生型超声引导下清宫术中出血量少于B组、C组,明显少于D组,差异均具有统计学意义(P<0.05),A组内生型住院时间短于D组,差异具有统计学意义(P<0.05),A组外生型住院时间与B组、C组差异无统计学意义,A组中内生型与外生型初始治疗成功率差异无统计学意义,内生型初始治疗成功率A组与D组差异无统计学意义,外生型初始治疗成功率A、B、C三组无差异无统计学意义。结论:CSP临床表现多样,初始治疗方法的选择需依据患者的不同情况以及诊疗经验和配备技术等因素综合考虑。
Objective: To analyze the clinical effect of different ways of initial treatment of uterine incision scar pregnancy. Methods: A total of 272 patients with scar pregnancy (CSP) diagnosed in our hospital from March 2009 to August 2013 were divided into four groups according to different treatment methods: group A, bilateral uterine arterial embolization (UAE) ) Underwent ultrasound-guided curettage in 140 cases (including 10 cases of hospital admission due to massive bleeding); group B, directly under the guidance of ultrasound-guided radical curettage in 54 cases; group C, methotrexate (MTX) Under the guidance of curettage in 51 cases; D group, transabdominal focal lesion resection in 27 cases; each group of patients according to their ultrasound image performance is divided into endogenous and exogenous. The blood β-HCG levels, initial treatment success rate, intraoperative blood loss, and hospital stay were compared between groups. Results: There was no significant difference in the serum β-HCG value between the four groups A, B, C and D on admission. There was no significant difference in the value of β-HCG among all the endogenous and exogenous groups. The endogenous and Exogenous blood loss and hospital stay, the success rate was no significant difference in group A, regardless of endogenous and exogenous ultrasound-guided bleeding in the curettage less than the B group, C group, significantly less than the D group, the difference (P <0.05). The length of hospital stay in group A was shorter than that in group D (P <0.05). There was no statistical difference between group A and group B Significance of the study, the success rate of endogenous and exogenous initial treatment in group A was no significant difference, the success rate of endogenous initial treatment group A and group D was not statistically significant, the initial success rate of exogenous treatment A, B, C three groups no difference was not statistically significant. Conclusion: The clinical manifestations of CSP are diverse. The choice of initial treatment should be based on the patients’ different situations, experience of diagnosis and treatment, and the equipment technique.