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目的探讨药物保守治疗及经阴道超声引导吸胚介入治疗子宫瘢痕妊娠的临床应用价值。方法瘢痕妊娠患者28例。血人绒毛膜促性腺激素(hCG)<2000U/L者,口服米非司酮+甲氨蝶呤联合药物保守治疗。血hCG>2000U/L者,经阴道超声全程监测,经阴道或经腹部穿刺进入妊娠囊、包块或瘢痕处;局部注射甲氨蝶呤或轻微抽吸后局部注射甲氨蝶呤。动态观察血hCG变化及超声观察瘢痕处血流阻力指数变化。结果治疗3d后,血hCG开始下降,5d后明显下降(P<0.05),4-6周完全恢复正常。治疗3d后瘢痕处血流阻力指数开始升高,5d后明显升高(P<0.01),4-6周完全恢复正常。结论药物保守治疗和超声引导下吸胚介入治疗是治疗瘢痕妊娠的良好选择。
Objective To investigate the clinical value of conservative treatment and transvaginal ultrasound-guided aspiration in the treatment of uterine scar pregnancy. Methods 28 cases of scar pregnancy. Human chorionic gonadotropin (hCG) <2000U / L, oral mifepristone + methotrexate combined with conservative treatment. Blood hCG> 2000U / L, the whole course of transvaginal ultrasound monitoring, vaginal or transabdominal puncture into the gestational sac, mass or scar; local injection of methotrexate or mild injection of local injection of methotrexate. Changes of hCG in blood and changes of blood flow resistance index in scars by ultrasound. Results After 3 days of treatment, blood hCG began to decline and decreased significantly after 5 days (P <0.05), and returned to normal after 4-6 weeks. After 3 days of treatment, the scar resistance index began to increase and was significantly increased after 5 days (P <0.01), and returned to normal after 4-6 weeks. Conclusion Conservative treatment and ultrasound-guided aspiration embryo intervention is a good choice for the treatment of scar pregnancy.