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  • 盛青菁,吴芝萍,洪玮,等.剖宫产瘢痕部位妊娠高危评估体系的研究[J].同济大学学报(医学版),2021,42(4):499-504.    [点击复制]
  • SHENG Qing-jing,WU Zhi-ping,HONG Wei,et al.High risk assessment system of cesarean scar pregnancy[J].同济大学学报(医学版),2021,42(4):499-504.   [点击复制]
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剖宫产瘢痕部位妊娠高危评估体系的研究
盛青菁,吴芝萍,洪玮,王蓓颖,李双弟,李晓翠
0
(同济大学附属第一妇婴保健院计划生育科,上海201204)
摘要:
目的回顾性分析150例剖宫产瘢痕部位妊娠(cesarean scar pregnancy, CSP)不同的治疗方案及疗效,探讨及验证CSP高危评估体系。方法收集2017年1月—2019年12月同济大学附属第一妇婴保健院收治的CSP患者150例,其中直接行刮宫术92例,子宫动脉栓塞术(uterine artery embolization, UAE)+甲氨蝶呤(methotrexate, MTX)化疗灌注后刮宫58例,以此将患者分为两组。回顾性分析两组临床资料(年龄、孕产次、距上次剖宫产时间、阴道出血情况、停经天数、孕囊大小、胎心搏动、CSP分型等),参照高危评估体系选择不同的治疗方案(低危者倾向于直接刮宫术、高危者倾向于UAE+MTX化疗灌注后刮宫、中危者根据患者意愿及有无生育需求等综合考虑后选择方案),观察临床疗效(出血量、手术时间、超声恢复情况及血β-人绒毛膜促性腺激素下降情况)以及预后(月经恢复)等。结果孕囊>2cm、有心管搏动、CSPⅢ型为高危因素,宜选择栓塞后刮宫治疗,符合高危评估;栓塞组术后血β-人绒毛膜促性腺激素下降水平、超声恢复正常者均高于直接刮宫组(P<0.05);栓塞组出现月经减少、闭经者高于直接刮宫组(P<0.05)。结论CSP评估为高危者,建议采取子宫动脉栓塞术+甲氨蝶呤化疗灌注后刮宫,可显著提高治疗安全性与有效性。
关键词:  剖宫产瘢痕妊娠  子宫动脉栓塞  甲氨蝶呤  化疗灌注  高危评估
DOI:10.12289/j.issn.1008-0392.20325
投稿时间:2020-07-26
基金项目:上海市自然科学基金(20ZR1444000)
High risk assessment system of cesarean scar pregnancy
SHENG Qing-jing,WU Zhi-ping,HONG Wei,WANG Bei-ying,LI Shuang-di,LI Xiao-cui
(Dept. of Family Planning, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 201204, China)
Abstract:
ObjectiveTo explore high risk assessment system for cesarean scar pregnancy(CSP). MethodsClinical data of 150 cases of CSP admitted to Department of Obstetrics and Gynecology of Shanghai First Maternity and Infant Hospital from January 2017 to December 2019 were retrospectively analyzed. Among them 92 cases underwent direct curettage and 58 cases underwent uterine artery embolization and methotrexate chemotherapy perfusion before curettage . The clinical data including age, times of pregnancy, intervals from last cesarean section, vaginal bleeding before operation, menopause days, gestational sac size, fetal heart beat and CSP classification were compared between two groups. Different treatment options were chosen according to the high-risk assessment system: low-risk patients tended to curettage directly, high-risk patients tended to curettage after UAE MTX chemotherapy infusion, middle-risk patients tended to choose either method according to the patients wishes and fertility needs and other comprehensive options. Clinical outcome including intraoperative bleeding volume, operation time, ultrasound recovery and blood β-HCG decrease, and prognosis(menstrual recovery) were also studied. Through analyzing these clinical data, the high risk assessment system of CSP was verified. ResultsGestational sac more than 2cm in diameter, fetal heart beat and CSP type III were the high-risk indicators in the evaluation system. The descend degree of blood β-HCG and the ultrasound recovery in curettage after UAE group were higher than those in direct curettage group(P<0.05); the incidence of hypomenorrhea and amenorrhea in UAE group was higher than that in direct curettage group(P<0.05). ConclusionThe curettage after uterine artery embolization combined with methotrexate chemotherapy is recommended for high risk patients who were assessed by high risk assessment system of cesarean scar pregnancy, which can significantly improve the safety and effectiveness of the treatment.
Key words:  cesarean scar pregnancy  uterine artery embolization  methotrexate  chemotherapy perfusion  high risk assessment

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