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目的探讨剖宫产术后子宫瘢痕妊娠(CSP)的临床特点和治疗方法。方法 112例剖宫产术后子宫瘢痕妊娠的患者分为米非司酮组(16例)、氨甲蝶呤(MTX)组(20例)、米非司酮+MTX组(35例)、子宫动脉栓塞术(UAE)+MTX组(41例)。观察四组的临床疗效。结果 UAE+MTX组术后血β-人绒毛膜促性腺激素(β-hCG)下降水平、阴道出血时间、月经恢复时间、住院时间均明显低于米非司酮组、MTX组、米非司酮+MTX组,差异均有统计学意义(P<0.01);但住院费用、治疗期间风险明显高于其他三组。治愈率:MTX组为90%,2例患者血β-hCG下降不理想,行B超监测下刮宫术,1周后复查血β-hCG下降,28 d降至正常;米非司酮组、米非司酮+MTX组、UAE+MTX组治愈率均为100%。结论剖宫产术后子宫瘢痕妊娠比较少见,临床表现不典型,易发生误诊误治。超声检查是有效的诊断方法。治疗方案应根据患者病情进行个体化综合治疗。
Objective To investigate the clinical features and treatment of uterine scar pregnancy (CSP) after cesarean section. Methods One hundred and twelve patients with uterine scar pregnancy after cesarean section were divided into mifepristone group (n = 16), methotrexate group (n = 20), mifepristone + MTX group (n = 35) Uterine artery embolization (UAE) + MTX group (41 cases). The clinical efficacy of the four groups was observed. Results The level of β-hCG, vaginal bleeding time, menstruation recovery time and hospital stay in UAE + MTX group were significantly lower than those in mifepristone group, MTX group, mifepristone group Ketone + MTX group, the differences were statistically significant (P <0.01); but the cost of hospitalization, the risk was significantly higher than the other three treatment groups. Cure rate: The MTX group was 90%, 2 cases of blood β-hCG decline is not ideal, under the B-monitoring curettage, 1 week after the review of blood β-hCG decreased 28 days to normal; mifepristone group, Mifepristone + MTX group, UAE + MTX group were 100% cure rate. Conclusion Cesarean scar pregnancy after pregnancy is relatively rare, clinical manifestations are not typical, prone to misdiagnosis and mistreatment. Ultrasonography is an effective diagnostic method. Treatment programs should be based on the patient’s condition for individualized comprehensive treatment.