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目的:分析剖宫产术后瘢痕妊娠(CSP)治疗方案选取及效果。方法:将惠州市第二妇幼保健院50例剖宫产术后瘢痕妊娠(CSP)患者按照分型差异分为A、B、C 3组。A组(n=16)为III型患者,予以肌注氨甲蝶呤、口服米非司酮及清宫术治疗,B组(n=16)为II型患者,予以超声引导下妊娠囊内注射氨甲蝶呤、口服米非司酮及清宫术治疗,C组(n=18)为I型患者,直接予以清宫术治疗,比较3组血β-人绒毛膜促性腺激素(β-HCG)恢复时间、术中出血量、术后阴道出血时间、转经时间以及孕囊彻底萎缩时间,手术成功率及并发症发生率。结果 C组血β-HCG恢复时间(36.31±15.20)d、术后阴道流血时间(24.26±9.16)d、孕囊完全萎缩时间(7.39±1.12)d、转经时间(30.96±8.62)d均短于A、B组,清宫术中出血量(30.01±25.13)m L少于A、B组,差异具有统计学意义(P<0.05);B组血β-HCG恢复时间、转经时间以及孕囊彻底萎缩时间明显短于A组,差异具有统计学意义(P<0.05);A、B组术中出血量与术后阴道出血时间比较,差异无统计学意义(P>0.05)。3组手术成功率与并发症发生率比较,差异无统计学意义(P>0.05)。结论:对I型剖宫产术后CSP患者直接予以清宫术进行治疗,获得的疗效最好,患者恢复快,治疗时间短,出血少,成功率高,并发症少,具有较好的临床应用价值。
Objective: To analyze the selection and effect of treatment of scar pregnancy (CSP) after cesarean section. Methods: Fifty patients with scar pregnancy (CSP) after cesarean section in the Second Maternal and Child Health Care Hospital of Huizhou City were divided into A, B and C groups. Group A (n = 16) was type III and received intramuscular methotrexate and oral mifepristone and curettage. Group B (n = 16) was type II and received ultrasound-guided intraperitoneal injection Methotrexate, oral mifepristone and curettage, C group (n = 18) was type I and was directly treated with curettage. The levels of β-human chorionic gonadotropin (β-HCG) Recovery time, intraoperative blood loss, postoperative vaginal bleeding time, menstrual cycle time and complete contraction of gestational sac, the success rate of surgery and the incidence of complications. Results The recovery time of β-HCG in group C (36.31 ± 15.20) d, postoperative vaginal bleeding time (24.26 ± 9.16) d, gestational sac complete collapse time (7.39 ± 1.12) d, (P <0.05). Compared with group A and B, the amount of blood loss during the operation of curettage (30.01 ± 25.13) m L was less than that of group A and B (P <0.05); The recovery time of β-HCG, The gestational sac completely shrinking time was significantly shorter than the A group, the difference was statistically significant (P <0.05); A, B group intraoperative blood loss and postoperative vaginal bleeding time, the difference was not statistically significant (P> 0.05). There was no significant difference between the three groups in surgical success rate and complication rate (P> 0.05). Conclusion: CSP patients with type I cesarean section were directly treated with curettage, the best effect was obtained, patients recovered quickly, the treatment time is short, less bleeding, high success rate, fewer complications, and has good clinical application value.