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目的探讨剖宫产瘢痕妊娠的诊断与治疗方法。方法回顾性分析37例剖宫产瘢痕妊娠患者的临床资料。结果剖宫产瘢痕妊娠占同期异位妊娠的6.9%,误诊率51.4%;36例经彩色多普勒超声确诊;手术治疗成功率94.7%,超声引导下病灶局部注射甲氨喋呤治疗成功率75%;手术患者治疗后2~3d血清人绒毛膜促性腺激素下降幅度高于超声引导下局部注射甲氨喋呤,住院时间、血清人绒毛膜促性腺激素降至<100u/L时间均明显低于超声引导下局部注射甲氨喋呤,其差异有统计学意义(P<0.05)。结论剖宫产瘢痕妊娠误诊率高,超声为主要检查及治疗方法,手术和病灶局部注射甲氨喋呤均是治疗剖宫产瘢痕妊娠的有效方法,但手术治疗更直接、有效、恢复快。
Objective To investigate the diagnosis and treatment of cesarean scar pregnancy. Methods Retrospective analysis of 37 cases of cesarean scar pregnancy in patients with clinical data. Results Cesarean scar pregnancy accounted for 6.9% of the ectopic pregnancy in the same period, misdiagnosis rate was 51.4%; 36 cases were diagnosed by color Doppler ultrasound; the success rate of operation was 94.7%; the success rate of local injection of methotrexate under ultrasound-guided lesion 75%. The decreasing rate of serum human chorionic gonadotropin 2 to 3 days after operation was higher than that of local injection of methotrexate under ultrasound guidance. The time of hospitalization and serum human chorionic gonadotropin decreased to <100u / L The difference was statistically significant (P <0.05), which was lower than that of ultrasound-guided local injection of methotrexate. Conclusion The misdiagnosis rate of cesarean scar pregnancy is high. Ultrasound is the main method of examination and treatment. Surgical and focal injection of methotrexate are both effective methods for cesarean scar pregnancy. However, surgical treatment is more direct, effective and faster recovery.