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目的探索更简单、经济、有效且风险相对低、便于更多医疗机构能开展的剖宫产瘢痕部位妊娠(caesarean scar pregnancy,CSP)治疗方法。方法回顾性分析78例北京市海淀区妇幼保健院2010年1月至2013年1月收住的剖宫产瘢痕部位妊娠患者,先用甲氨蝶呤联合米非司酮药物治疗,在血β-hCG呈下降趋势后宫腔镜直视下清除妊娠组织,术后宫腔局部给予Foley双腔尿管球囊压迫,观察治疗的成功率、术中术后出血量、急诊清宫率、二次清宫率、不良反应发生率,并且比较了甲氨蝶呤不同给药途径治疗效果的差异。结果 78例患者100%治疗成功,78.2%(61/78)的患者术中术后出血<200ml,20%(15/78)行急诊清宫,11.5%(9/78)行宫腔镜下二次清宫,60.3%(47/78)有球囊压迫,75.6%(59/78)无不良反应。甲氨蝶呤三种不同给药途径的治疗效果无差异。结论药物联合宫腔镜下清宫及球囊压迫治疗剖宫产瘢痕部位妊娠成功率高,疗效可靠,副作用少,便于基层医院推广。
Objective To explore caesarean scar pregnancy (CSP) treatment which is simpler, more economical, more effective and less risky to facilitate more medical institutions to carry out. Methods A retrospective analysis of 78 cases of pregnant women with cesarean section scar in Haidian District Maternal and Child Health Hospital from January 2010 to January 2013 were treated with methotrexate combined with mifepristone, -hCG showed a downward trend after hysteroscopy to clear the pregnant tissue under direct vision, intrauterine postoperative Foley dual-chamber catheter balloon pressure to observe the success rate of treatment, postoperative blood loss, emergency curettage rate, the second Qing Rate, the incidence of adverse reactions, and compared the different effects of methotrexate treatment route of treatment. Results 78 patients (100%) were successful in treatment and 78% (61/78) had postoperative bleeding less than 200ml and 20% (15/78) in emergency hysteroscopy and 11.5% (9/78) hysteroscopy in hysteroscopy Qing Palace, 60.3% (47/78) with balloon compression, 75.6% (59/78) no adverse reactions. Methotrexate treatment of three different ways of no difference. Conclusion The combination of hysteroscopic and hysteroscopic treatment of cesarean section with cesarean section and cicatricial scar has a high success rate of pregnancy, reliable curative effect and few side effects, which is convenient for the promotion of primary hospitals.