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目的观察不同方法治疗子宫切口瘢痕妊娠(cesarean scar pregnancy,CSP)的临床效果。方法将111例CSP患者分为4组,分别采用甲氨蝶呤(methotrexate,MTX)全身用药、MTX局部注射、子宫动脉栓塞、手术治疗,分析监测治疗后1周血人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)情况及转阴时间,观察治疗期间阴道出血情况及不良反应、治疗后包块超声影像变化,分析住院天数、住院费用及治愈率。结果手术治疗血HCG下降最快,住院时间、包块消失时间及HCG转阴时间最短,子宫动脉栓塞治疗次之,与MTX全身用药组比较差异均有统计学意义(P<0.05);MTX局部注射对孕囊型的疗效明显优于团块型;子宫动脉栓塞治疗费用最高。结论 CSP的治疗应实行个体化治疗,MTX局部注射可作为孕囊型患者治疗的首选方法,子宫动脉栓塞治疗可作为团块型患者的首选治疗方法,对于保守治疗无效者可改行子宫病灶切除+修复术。
Objective To observe the clinical effect of different methods in treating cesarean scar pregnancy (CSP). Methods One hundred and 111 CSP patients were divided into 4 groups. The patients were treated with methotrexate (MTX) systemic, MTX injection, uterine arterial embolization and operation. The levels of human chorionic gonadotropin Human chorionic gonadotropin (HCG) and negative conversion time were observed. Vaginal bleeding and adverse reactions during treatment were observed. Ultrasonographic changes of mass after treatment were analyzed. The days of hospitalization, hospitalization and cure rate were analyzed. Results The surgical treatment of HCG decreased the fastest, the length of hospital stay, the disappearance of mass and HCG, the shortest time of uterine artery embolization, and MTX systemic administration group, the differences were statistically significant (P <0.05); MTX local Injection of gestational sac-type effect was significantly better than the block type; uterine artery embolization the highest cost. Conclusion The treatment of CSP should be individualized treatment, local injection of MTX can be used as the preferred method of treatment of gestational sac-type patients, uterine artery embolization can be used as the preferred treatment for patients with clumps, for conservative treatment ineffective can be diverted to hysterectomy + Repair surgery.