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目的:探讨剖宫产瘢痕部位妊娠(cesarean scar pregnancy,CSP)出血的止血方法及其适应证。方法:对95例CSP出血患者依据止血方法不同分为4组,A组采用纱条填塞压迫宫腔下段及切口处止血;B组采用Foley导管压迫宫腔下段及切口处止血;C组采用经腹或腹腔镜下病灶切除术止血;D组采用子宫动脉栓塞术(uterine artery embolization,UAE)止血。回顾性分析其临床资料。结果:患者治疗前估计出血量、停经天数、治疗前血β-hCG值、超声显示孕囊或胚胎组织物3径线之和的平均数,超声显示妊娠物距浆膜面的组织厚度4组间的比较,差异有统计学意义(P<0.05)。治疗后的出血量和治疗前后血红蛋白(Hb)的变化值,4组间比较差异有统计学意义(P<0.05)。结论:4种止血方法在治疗中均成功止血,临床工作中依据患者病情的不同需要,可以独立应用,也可以同时或交叉应用,并结合以往的临床经验,对患者采取个性化的治疗,可达到保留患者的生育能力、减少出血等并发症效果。
Objective: To investigate the method and indication of hemostasis for cesarean scar pregnancy (CSP) hemorrhage. Methods: Ninety-five patients with CSP hemorrhage were divided into four groups according to the method of hemostasis. In group A, sliver packing was used to compress the lower uterine segment and incision to stop bleeding. In group B, Foley catheter was used to compress the lower segment of uterine cavity and incision to stop bleeding. Abdominal or laparoscopic resection of the lesion to stop bleeding; D group uterine artery embolization (uterine artery embolization, UAE) to stop bleeding. Retrospective analysis of its clinical data. Results: The amount of bleeding, days of menopause, β-hCG before treatment, and the average of the sum of the diameter of the gestational sac or embryo tissue 3 were shown before treatment. The thickness of the tissue from the serosal surface was measured by ultrasound. The difference was statistically significant (P <0.05). The amount of bleeding after treatment and the change of hemoglobin (Hb) before and after treatment were significantly different among the four groups (P <0.05). Conclusion: All the four hemostatic methods are successful in the treatment of hemostasis. According to the different needs of patients’ condition, the four kinds of hemostasis can be applied independently or simultaneously or in combination. Based on previous clinical experience, patients can be treated individually, Retention of patients to achieve fertility and reduce complications such as bleeding effect.