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目的:对比分析子宫动脉栓塞(UAE)联合化疗和单纯化疗在保守性治疗剖宫产瘢痕妊娠(CSP)的效果及相关影响因素。方法:选取2003年1月~2014年12月在中山大学附属第一医院确诊CSP且拒绝手术治疗的60例患者,其中22例行单纯MTX化疗,38例行UAE联合化疗。结果:单纯MTX化疗组中6例(27.3%)失败,化疗失败者的治疗前血β-HCG平高于化疗成功者(P=0.001)。UAE联合化疗组中2例(5.3%)治疗失败,住院时间、β-HCG转阴、正常月经恢复时间均较单纯MTX化疗组显著缩短(P<0.001),术后血β-HCG转阴及正常月经恢复与治疗前血β-HCG、孕周、妊娠囊大小等因素无相关性。结论:UAE联合化疗较单纯MTX化疗更有效,术后康复较快,且不受患者个体因素的影响。而治疗前高β-HCG是导致单纯MTX化疗失败的相关因素。
Objective: To compare and analyze the effect of uterine artery embolization (UAE) combined with chemotherapy and chemotherapy alone in the conservative treatment of cesarean scar pregnancy (CSP) and the related influential factors. Methods: From January 2003 to December 2014, 60 patients with confirmed CSP and no surgical treatment in the First Affiliated Hospital of Sun Yat-sen University were enrolled. Twenty-two patients underwent simple MTX chemotherapy and 38 patients underwent UAE combined with chemotherapy. Results: Six patients (27.3%) failed MTX chemotherapy alone. The pretreatment blood β-HCG levels of those who failed chemotherapy were significantly higher than those of chemotherapy-successful patients (P = 0.001). UAE combination chemotherapy group 2 cases (5.3%) failed to treat, hospitalization time, β-HCG negative, normal menstruation recovery time were significantly shorter than the MTX chemotherapy group (P <0.001), postoperative blood β-HCG negative and Normal menstruation and treatment of blood before the β-HCG, gestational age, gestational sac size and other factors were not related. CONCLUSION: UAE combined with chemotherapy is more effective than MTX alone in the treatment of postoperative recovery faster, and not affected by individual patient factors. However, high-β-HCG before treatment is a related factor in the failure of simple MTX chemotherapy.