[1]石延辉.超声引导下精准介入治疗不同超声分型子宫瘢痕妊娠疗效观察[J].新乡医学院学报,2018,35(8):722-726.[doi:10.7683/xxyxyxb.2018.08.019]
　SHI Yan-hui.Clinical effect of ultrasound guided interventional therapy in different ultrasonic types of cesarean scar pregnancy[J].Journal of Xinxiang Medical University,2018,35(8):722-726.[doi:10.7683/xxyxyxb.2018.08.019]
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超声引导下精准介入治疗不同超声分型子宫瘢痕妊娠疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
35
期数:
2018年8
页码:
722-726
栏目:
临床研究
出版日期:
2018-08-05

文章信息/Info

Title:
Clinical effect of ultrasound guided interventional therapy in different ultrasonic types of cesarean scar pregnancy
作者:
石延辉
（中国人民解放军第152中心医院超声科，河南　平顶山　467000）
Author(s):
SHI Yan-hui
（Department of Ultrasonography，the 152nd Central Hospital of the Chinese People′s Liberation Army，Pingdingshan 467000，Henan Province，China）
关键词:
瘢痕妊娠; 精准介入治疗; 甲氨蝶呤; 刮宫术
Keywords:
cicatricial pregnancy; precise interventional therapy; methotrexate; curettage
分类号:
R445.1；R714.2
DOI:
10.7683/xxyxyxb.2018.08.019
文献标志码:
A
摘要:
目的　探讨超声引导下精准介入治疗不同超声分型子宫瘢痕妊娠的临床疗效。方法　选择2009年5月至2017年5月中国人民解放军第152中心医院收治的子宫瘢痕妊娠患者322例，将所有患者根据彩色多普勒超声检查结果分为低血流包块型（70例）、高血流包块型（80例）、低血流孕囊型（86例）、高血流孕囊型（86例）。对4种超声分型子宫瘢痕妊娠患者采取肌肉注射甲氨蝶呤、超声引导下刮宫术及超声引导下精准介入治疗，比较3种方法治疗后4种超声分型子宫瘢痕妊娠患者的阴道出血量、血β人绒毛膜促性腺激素（β-HCG）恢复至正常时间、治疗成功率及住院时间等。结果　肌肉注射甲氨蝶呤、超声引导下刮宫术及超声引导下精准介入治疗低血流包块型子宫瘢痕妊娠患者的阴道出血量、血β-HCG恢复至正常时间、治疗成功率及住院时间比较差异无统计学意义（P>0.05）。超声引导下精准介入治疗高血流包块型子宫瘢痕妊娠患者的阴道出血量、血β-HCG恢复至正常时间及住院时间显著低于肌肉注射甲氨蝶呤和超声引导下刮宫术治疗患者（P<0.05），且治疗成功率显著高于肌肉注射甲氨蝶呤和超声引导下刮宫术治疗患者（P<0.05）；肌肉注射甲氨蝶呤和超声引导下刮宫术治疗高血流包块型子宫瘢痕妊娠患者的阴道出血量、血β-HCG恢复至正常时间、治疗成功率及住院时间比较差异无统计学意义（P>0.05）。超声引导下刮宫术和超声引导下精准介入治疗低血流孕囊型子宫瘢痕妊娠患者的血β-HCG恢复至正常时间、住院时间显著低于肌肉注射甲氨蝶呤治疗患者（P<0.05）；超声引导下刮宫术治疗低血流孕囊型子宫瘢痕妊娠患者的住院时间显著低于超声引导下精准介入治疗（P<0.05）；超声引导下刮宫术和超声引导下精准介入治疗低血流孕囊型子宫瘢痕妊娠患者血β-HCG恢复至正常时间比较差异无统计学意义（P>0.05）；3种方法治疗低血流孕囊型子宫瘢痕妊娠患者的阴道出血量和治疗成功率比较差异无统计学意义（P>0.05）。超声引导下精准介入治疗高血流孕囊型子宫瘢痕妊娠患者的阴道出血量、血β-HCG恢复至正常时间及住院时间显著低于肌肉注射甲氨蝶呤和超声引导下刮宫术治疗患者（P<0.05），治疗成功率显著高于肌肉注射甲氨蝶呤和超声引导下刮宫术治疗患者（P<0.05）；肌肉注射甲氨蝶呤和超声引导下刮宫术治疗高血流孕囊型子宫瘢痕妊娠患者的阴道出血量、血β-HCG恢复至正常时间、治疗成功率及住院时间比较差异无统计学意义（P>0.05）。结论　超声引导下精准介入治疗不同超声分型子宫瘢痕妊娠患者均有较好的临床疗效，尤其在治疗高血流包块型及高血流孕囊型子宫瘢痕妊娠患者中，具有减少阴道出血、缩短血β-HCG恢复至正常时间和住院时间、提高治疗成功率等优点。
Abstract:
Objective　To explore the clinical effect of ultrasound guided interventional therapy in different ultrasonic types of cesarean scar pregnancy.Methods　Three hundred and twenty-two patients with uterine scar pregnancy were chosen in the the 152nd Central Hospital of the Chinese People′s Liberation Army from May 2009 to May 2017.All the patients were divided into low blood bag piece type （70 cases），high blood bag piece type （80 cases），low blood flow pregnant bursa type （86 cases） and high blood flow pregnant bursa type （86 cases） according to the result of color doppler ultrasound examination.The patients in the four types of uterine scar pregnancy were given intramuscular methotrexate treatment，curettage surgery under the guidance of ultrasound and ultrasound guided interventional therapy according to the will of the patients.The amount of vaginal haemorrhage，blood β human chorionic gonadotropin （β-HCG） returned to normal time，treatment success rate and length of hospital stay were compared in the three treatments.Results　There was no significant difference in the amount of vaginal haemorrhage，blood β-HCG returned to normal time，treatment success rate and length of hospital stay in the low blood bag piece type patients with the treatments of intramuscular methotrexate，curettage surgery under the guidance of ultrasound and ultrasound guided precision interventional treatment （P>0.05）.The amount of vaginal haemorrhage，blood β-HCG returned to normal time and length of hospital stay in the high blood bag piece type patients with the treatment of ultrasound guided precision intervention were lower and the treatment success rate was significantly higher than those in the patients treated with intramuscular injection of methotrexate and curettage surgery under the guidance of ultrasound （P<0.05）；there was no significant difference in the amount of vaginal haemorrhage，blood β-HCG returned to normal time，treatment success rate and length of hospital stay between the treatment of intramuscular methotrexate and curettage surgery under the guidance of ultrasound for high blood bag piece type patients （P>0.05）.The blood β-HCG returned to normal time and length of hospital stay in the low blood flow pregnant bursa patients treated with curettage surgery under the guidance of ultrasound and ultrasound guided interventional therapy were lower than those in the patients treated with intramuscular methotrexate（P<0.05）.The length of hospital stay in the low blood flow pregnant bursa patients treated with curettage surgery under the guidance of ultrasound was lower than that in the patients treated with ultrasound guided interventional therapy （P<0.05）.There was no significant difference in the blood β-HCG returned to normal time between the treatment of curettage surgery under the guidance of ultrasound and ultrasound guided interventional therapy for low blood flow pregnant bursa patients （P>0.05）.There was no significant difference in the amount of vaginal haemorrhage，treatment success rate in the treatment of intramuscular methotrexate，curettage surgery under the guidance of ultrasound and ultrasound guided interventional therapy for high blood bag piece type patients （P>0.05）.The amount of vaginal haemorrhage，blood β-HCG returned to normal time and length of hospital stay was lower and the treatment success rate was higher in the high blood flow pregnant bursa type patients treated with ultrasound guided interventional therapy than those in the patients treated with intramuscular methotrexate and curettage surgery under the guidance of ultrasound（P<0.05）.There was no significant difference in the amount of vaginal haemorrhage，blood β-HCG returned to normal time，treatment success rate and length of hospital stay between the treatment of intramuscular methotrexate and curettage surgery under the guidance of ultrasound for high blood flow pregnant bursa patients（P>0.05）.Conclusion　Guided by ultrasound accurate interventional therapy for different ultrasonic classification of uterine scar pregnancy has better clinical curative effect，especially in the treatment of high blood bag piece type and high blood flow pregnant bursa patients with lower amount of vaginal haemorrhage，shorter the β-HCG returned to normal time and hospitalization time and higher treatment success.

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更新日期/Last Update: 2018-08-05