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目的:探讨剖宫产瘢痕部位妊娠(cesarean scar pregnancy,CSP)3种治疗方法的优缺点。方法:回顾性分析93例CSP患者,其中35例患者行甲氨蝶呤(MTX)+米非司酮+B超定位下清宫治疗(A组),18例行MTX+米非司酮+B超定位下宫腔镜治疗(B组),40例行子宫动脉介入栓塞治疗+B超定位下清宫术(C组)。结果:1 A组术中出血160.4±77.7 ml,多于B组(90.5±41.4 ml)和C组(73.3±51.0 ml)。2 A组住院时间为23.7±6.6 d,长于B组(10.8±2.4 d)和C组(10.0±1.9 d)(P<0.05),差异有统计学意义(P<0.05)。3 C组出院前血β-h CG为2 130±277 U/L,高于B组(315.5±127.5 U/L)和A组(117.31±76 U/L),但血β-h CG恢复至正常时间47.4±11.8 d,短于B组(58.7±10.9 d)和A组(62.6±10.4 d),差异有统计学意义(P<0.05),提示A组疗效佳,恢复快,而B组、C组间差异无统计学差异(P>0.05)。4住院费用C组最高,平均11 903±1 309元,B组次之(5 960±338元),A组最少(5 054±778元)。结论:3种治疗方法各有优缺点,介入治疗最安全有效,但费用高,不考虑住院费用的情况下,可作为首选方法,尤其适合发生大出血的患者。但在血β-h CG水平较低、胚胎活性较低的情况下可以考虑清宫治疗或者宫腔镜治疗,其住院费用较低,操作方便,适合基层医院开展。
Objective: To investigate the advantages and disadvantages of three treatment methods of cesarean scar pregnancy (CSP) at cesarean section. Methods: Ninety-three patients with CSP were retrospectively analyzed. Thirty-five patients underwent methotrexate (MTX) plus mifepristone plus B-statin therapy (group A) and 18 patients underwent MTX plus mifepristone plus B- Hysteroscopic positioning (B group), 40 cases of uterine artery interventional embolization + B-positioning under Qing Palace operation (C group). Results: The intraoperative bleeding in group A was 160.4 ± 77.7 ml, more than that in group B (90.5 ± 41.4 ml) and group C (73.3 ± 51.0 ml). The length of hospital stay in group A was 23.7 ± 6.6 d, longer than that in group B (10.8 ± 2.4 d) and group C (10.0 ± 1.9 d) (P <0.05). The difference was statistically significant (P <0.05). The blood β-h CG in group 3 C before discharge was 2130 ± 277 U / L, which was higher than that in group B (315.5 ± 127.5 U / L) and group A (117.31 ± 76 U / L) (47.4 ± 11.8 d), which was shorter than that of group B (58.7 ± 10.9 d) and group A (62.6 ± 10.4 d) (P <0.05), which indicated that group A had better curative effect and faster recovery than group B There was no significant difference between group C and group C (P> 0.05). The cost of hospitalization in group C was the highest, with an average of 11 903 ± 1 309 yuan, followed by group B 5 596 ± 338 yuan and group A the least (5 054 ± 778 yuan). Conclusion: The three kinds of treatment have their own advantages and disadvantages, the most safe and effective interventional therapy, but the high cost, without considering the cost of hospitalization can be used as the preferred method, especially for patients with massive bleeding. But in the blood of low level of β-hCG, lower embryo activity can be considered under the treatment of hysteroscopy or hysteroscopy, the hospitalization costs are lower, easy to operate, suitable for primary hospital.