剖宫产瘢痕部位妊娠四种治疗方法有效性及优缺点对比研究(1)
摘要：目的 评价和对比分析剖宫产瘢痕部位妊娠的(CSP)4种治疗方法有效性及优缺点。方法 回顾性分析我院2014年1月～2015年12月共收治的80例CSP患者的病例资料。该80例患者按照不同的治疗方法分成四组。药物组20例采用药物保守治疗，清宫组20例采用直接清宫治疗，栓塞组采用双侧子宫动脉栓塞后清宫手术治疗，手术组采用剖腹或是经阴式手术行病灶清除术，比较四组患者治疗过程中出血量、住院天数等相关指标。结果 通过临床治疗分析，其中四组患者的出血量分别为(216.2±16.5)、(86.2±8.9)、(58.3±11.6)、(867.21±27.5)ml；四组住院天数中值为9、4、7、10 d，各组以上数据组间比较差异有显着性(P<0.05)。结论 通过本研究表明，药物治疗出血多，累计住院时间及住院费用较高，不主张作为治疗首选；子宫动脉栓塞治疗可以明显降低出血风险，鼓励积极选择；手术治疗对于凶险性及孕周较大患者联合子宫动脉栓塞治疗可以增加保留子宫的几率。
关键词：剖宫产；瘢痕部位妊娠；有效性
, http://www.100md.com
中图分类号：R714.22 文献标识码：A 文章编号：1006-1959(2017)26-0066-02
Abstract：Objective To evaluate and compare the effectiveness and advantages and disadvantages of four treatments of pregnancy induced by cesarean section(CSP).Methods A retrospective analysis of 80 cases of CSP patients treated in our hospital from January 2014 to December 2015 were included.80 patients were divided into four groups according to different treatment methods.20 patients in the drug group were treated conservatively.In curettage group，20 cases were treated with direct curettage，and the embolization group was treated with curettage after bilateral uterine artery embolization，the operation group with laparotomy or transvaginal surgical debridement，the amount of bleeding were compared between the four groups in the course of treatment，hospitalization and other related indicators.Results Through the analysis of the clinical treatment，the amount of bleeding of the four groups of patients respectively(216.2±16.5)，(86.2±8.9)，(58.3±11.6)，(867.21±27.5)ml；four groups of hospital days the value of 9，4，7，10 d，the data in each group above differences were significant(P<0.05).Conclusion The results of this study show that drug treatment of bleeding，total hospitalization time and cost is high，do not advocate for the treatment of choice；uterine artery embolization therapy can significantly reduce the risk of bleeding，encourage positive selection；surgical treatment for dangerous and gestational age patients combined uterine artery embolization in the treatment can increase the chance to retain the uterus.
, http://www.100md.com
Key words：Cesarean section；Scar pregnancy；Effectiveness
剖宫产瘢痕部位妊娠(cesarean scar pregnancy，CSP)是剖宫产术后的一种远期性并发症[1]。从20世纪50年代以来，剖宫产术一般均采用子宫下段术式，子宫下段切口瘢痕妊娠的位置相当于子官峡部并全于子宫腔以外，严格地说是一种特殊部位的异位妊娠。确诊为剖宫产瘢痕部位妊娠(CSP)患者应及时给予积极对症治疗，因为随着病情进一步的发展，会导致子宫肌层与之粘连，从而出现穿孔或者破裂等严重威胁患者生命的并发症发生情况。目前临床相关数据统计表明，剖宫产率呈上升性发展趋势，同时，发生CSP的患者亦越来越多[2]。针对此情况，选择哪种方法更有效治疗剖宫产瘢痕部位妊娠，有效提高临床治疗效果及预后，同时降低并发症的发生是目前临床主要考虑的問题。本次研究回顾性分析我院2014年1月～2015年12月共收治的80例CSP患者的病例资料，进行四种不同的治疗方法，包括：①药物保守治疗；②直接清宫治疗；③双侧子宫动脉栓塞后清宫手术治疗；④剖腹或是经阴式手术行病灶清除术。观察各组的治疗效果，现报告如下。, http://www.100md.com(段秀芳)
关键词：剖宫产；瘢痕部位妊娠；有效性
, http://www.100md.com
中图分类号：R714.22 文献标识码：A 文章编号：1006-1959(2017)26-0066-02
Abstract：Objective To evaluate and compare the effectiveness and advantages and disadvantages of four treatments of pregnancy induced by cesarean section(CSP).Methods A retrospective analysis of 80 cases of CSP patients treated in our hospital from January 2014 to December 2015 were included.80 patients were divided into four groups according to different treatment methods.20 patients in the drug group were treated conservatively.In curettage group，20 cases were treated with direct curettage，and the embolization group was treated with curettage after bilateral uterine artery embolization，the operation group with laparotomy or transvaginal surgical debridement，the amount of bleeding were compared between the four groups in the course of treatment，hospitalization and other related indicators.Results Through the analysis of the clinical treatment，the amount of bleeding of the four groups of patients respectively(216.2±16.5)，(86.2±8.9)，(58.3±11.6)，(867.21±27.5)ml；four groups of hospital days the value of 9，4，7，10 d，the data in each group above differences were significant(P<0.05).Conclusion The results of this study show that drug treatment of bleeding，total hospitalization time and cost is high，do not advocate for the treatment of choice；uterine artery embolization therapy can significantly reduce the risk of bleeding，encourage positive selection；surgical treatment for dangerous and gestational age patients combined uterine artery embolization in the treatment can increase the chance to retain the uterus.
, http://www.100md.com
Key words：Cesarean section；Scar pregnancy；Effectiveness
剖宫产瘢痕部位妊娠(cesarean scar pregnancy，CSP)是剖宫产术后的一种远期性并发症[1]。从20世纪50年代以来，剖宫产术一般均采用子宫下段术式，子宫下段切口瘢痕妊娠的位置相当于子官峡部并全于子宫腔以外，严格地说是一种特殊部位的异位妊娠。确诊为剖宫产瘢痕部位妊娠(CSP)患者应及时给予积极对症治疗，因为随着病情进一步的发展，会导致子宫肌层与之粘连，从而出现穿孔或者破裂等严重威胁患者生命的并发症发生情况。目前临床相关数据统计表明，剖宫产率呈上升性发展趋势，同时，发生CSP的患者亦越来越多[2]。针对此情况，选择哪种方法更有效治疗剖宫产瘢痕部位妊娠，有效提高临床治疗效果及预后，同时降低并发症的发生是目前临床主要考虑的問题。本次研究回顾性分析我院2014年1月～2015年12月共收治的80例CSP患者的病例资料，进行四种不同的治疗方法，包括：①药物保守治疗；②直接清宫治疗；③双侧子宫动脉栓塞后清宫手术治疗；④剖腹或是经阴式手术行病灶清除术。观察各组的治疗效果，现报告如下。, http://www.100md.com(段秀芳)
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