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目的:比较剖宫产术后切口瘢痕妊娠不同治疗方法的有效性。方法:90例切口瘢痕妊娠分为3组:甲氨蝶呤(MTX)组30例、穿刺组30例、介入组30例。用化学发光法检测各组血β-hCG值,B超监测切口瘢痕血流指数,比较各组治疗后血β-hCG、切口瘢痕血流指数、血细胞的变化情况,以及各组的住院时间和转经时间。结果:①介入组血β-hCG下降最快,治疗1周后比原基础值下降80%,而以后则下降缓慢。其次是穿刺组,MTX组血β-hCG下降最慢。②介入组治疗后1～2周,切口瘢痕血流指数明显小于术前。③各组治疗前平均血红蛋白为116.4±8.74g/L、白细胞为6.56±1.99×109/L;治疗后2周平均血红蛋白为113.4±11.6g/L、白细胞为7.35±2.77×109/L,各组血细胞的变化均无明显差异(P>0.05)。④各组住院时间:MTX组38.4±8.4d、穿刺组33.5±4.0d、介入组16.4±7.9d,3组间有显著性差异(P<0.05)。⑤转经时间:MTX组60.0±9.6d、穿刺组50.7±6.5d、介入组36.7±16.7d,3组间有显著性差异(P<0.05)。结论:子宫动脉栓塞术加刮宫术的介入方法明显比单纯MTX或孕囊穿刺术的效果好,缩短了住院时间,月经恢复也较快,子宫动脉栓塞术加刮宫术是目前值得推广应用的技术。
OBJECTIVE: To compare the effectiveness of different treatments for cesarean scar pregnancy. Methods: 90 cases of incisional scar pregnancy were divided into 3 groups: methotrexate (MTX) group 30 cases, puncture group 30 cases, intervention group 30 cases. The blood levels of β-hCG in each group were detected by chemiluminescence method, and the scar flow index was monitored by B-ultrasound. The changes of blood β-hCG, incisional scar flow index and blood cells in each group were compared, and the length of stay and Transfer time. Results: ① The serum β-hCG in the intervention group decreased most rapidly, decreased by 80% one week after treatment, but decreased slowly later. Followed by the puncture group, MTX group, the slowest decline in blood β-hCG. ②In the intervention group 1 to 2 weeks after treatment, incision scar flow index was significantly less than before surgery. ③ The average hemoglobin before treatment was 116.4 ± 8.74g / L, and the white blood cells was 6.56 ± 1.99 × 109 / L. The average hemoglobin at two weeks after treatment was 113.4 ± 11.6g / L, and the white blood cells was 7.35 ± 2.77 × 109 / L There was no significant difference in blood cell changes (P> 0.05). ④ The length of stay in each group: 38.4 ± 8.4 days in MTX group, 33.5 ± 4.0 days in puncture group and 16.4 ± 7.9 days in intervention group, there were significant differences among the three groups (P <0.05). ⑤Transfer time: MTX group 60.0 ± 9.6d, puncture group 50.7 ± 6.5d, intervention group 36.7 ± 16.7d, there was significant difference between the three groups (P <0.05). Conclusion: The interventional method of uterine artery embolization plus curettage is obviously better than that of simple MTX or gestational sac puncture, shortening the length of hospital stay and rapid recovery of menstruation. Uterine arterial embolization plus curettage is currently worth popularizing. .