| 摘要: |
| 目的通过分析剖宫产术后外生型瘢痕妊娠患者的治疗及随访妊娠相关情况等临床资料，探讨外生型瘢痕妊娠患者的治疗方法选择，并研究对再次生育功能影响。方法收集2009年1月至2013年1月就诊的外生型瘢痕妊娠患者38例，分为甲组20例，行开腹子宫局灶切除术+瘢痕修补术；乙组18例，行经阴道孕囊注射甲氨蝶呤（MTX）+清宫术。观察两组患者治疗过程中出血量、住院时间、人绒毛膜促性腺激素（HCG）转阴时间及3个月后瘢痕厚度，并随访再次妊娠事件发生情况，分析比较剖宫产术后外生型瘢痕妊娠两种不同治疗方法的临床疗效及其对生育功能影响情况。结果甲组所有患者均治疗成功，乙组2例治疗失败。两组患者手术出血量、HCG转阴时间、3个月后瘢痕厚度、瘢痕妊娠再发和子宫破裂发生率比较差异均有统计学意义（均P＜0.05），但异位妊娠、稽留流产和早产发生率比较差异均无统计学意义（均P＞0.05）。结论外生型瘢痕妊娠采用开腹子宫局灶切除术+瘢痕修补术疗效更为理想，其可减少出血量，且妊娠相关不良事件发生率低，手术治疗是剖宫产术后外生型瘢痕妊娠保护生育功能可靠的治疗方案。 |
| 关键词: 剖宫产瘢痕妊娠 妇科外科手术 妊娠 分娩 |
| DOI： |
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| 基金项目:温州市公益性科技计划项目 |
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| Different methods for treatment of exogenous cesarean scar pregnancy and its relation to reproductive function |
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GUO Fang, CHEN Yumei, LIU Li, WANG Qinxiao
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Wenzhou People's Hospital
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| Abstract: |
| Objective To compare different methods for treatment of exogenous cesarean scar pregnancy and its relation to reproductive function. Methods Thirty eight women with exogenous scar pregnancy were admitted in our hospital from January 2009 to January 2013. Among 38 patients, 20 cases underwent uterine focal excision and scar repair (group A) and 18 cases received vaginal gestational sac injection of methotrexate (MTX) and curettage (group B). The amount of bleeding, length of hospitalization, HCG negative conversion time, postoperative uterine section thickness were observed and compared between two groups. The pregnancy events and effects on fertility were followed up in two groups. Results All patients were treated successfully in group A, 2 cases were failed in group B. There were significant difference in the amount of bleeding, HCG negative conversion time, postoperative uterine section thickness, recurrence rate of scar pregnancy, incidence of uterine rupture between two groups (all P ＜0.05). But there were no significant difference in ectopic pregnancy, missed abortion and the incidence of premature delivery between two groups (all P ＞0.05). Conclusion Uterine focal excision with scar repair is more effective for exogenous cesarean scar pregnancy with less bleeding and pregnancy related adverse events. |
| Key words: Cesarean scar pregnancy Gynecologic surgical procedures Pregnancy Delivery |
