CAJ | 학술논문

目的：探讨剖宫产术后瘢痕妊娠（ CSP）患者妊娠物局部注射甲氨蝶呤（ MTX）治疗后，经阴道超声检查是否对疗效评价有意义，如何早期发现病程中大量阴道流血的患者，及早进行干预。方法回顾性分析扬州市妇幼保健院收治的21例CSP患者，分析治疗前后超声影像学的改变对治疗效果评价有无辅助作用，病程中发生大量阴道流血的患者的临床特点。结果所有患者治疗前后超声均有改变，联合血β－人绒毛促性腺激素（β－hCG）分析，治疗后B超影像学检查可用于评价疗效。21例CSP病程中阴道流血≥200 mL者5例，其中妊娠囊型2例，包块型3例，病程中复查B超均发现包块进行性增大，如合并血流丰富者，则更易发生难以控制的阴道大量流血。结论治疗后B超影像学检查可用于药物保守治疗效果的评价，药物保守治疗后B超提示包块增大或妊娠物周边血流丰富，则病程中极易发生难以控制的阴道大量流血。
목적：탐토부궁산술후반흔임신（ CSP）환자임신물국부주사갑안접령（ MTX）치료후，경음도초성검사시부대료효평개유의의，여하조기발현병정중대량음도류혈적환자，급조진행간예。방법회고성분석양주시부유보건원수치적21례CSP환자，분석치료전후초성영상학적개변대치료효과평개유무보조작용，병정중발생대량음도류혈적환자적림상특점。결과소유환자치료전후초성균유개변，연합혈β－인융모촉성선격소（β－hCG）분석，치료후B초영상학검사가용우평개료효。21례CSP병정중음도류혈≥200 mL자5례，기중임신낭형2례，포괴형3례，병정중복사B초균발현포괴진행성증대，여합병혈류봉부자，칙경역발생난이공제적음도대량류혈。결론치료후B초영상학검사가용우약물보수치료효과적평개，약물보수치료후B초제시포괴증대혹임신물주변혈류봉부，칙병정중겁역발생난이공제적음도대량류혈。
Objective To investigate curative effect of local injection of Methotrexate ( MTX) on cesarean scar pregnancy ( CSP) and how to detect and prevent severe vaginal bleeding.Methods A retrospective analysis was conducted on the data of 21 cases of CSP admitted in Yangzhou Women and Child Health Hospital.The changes in ultrasonic images were analyzed, and the clinical features of the patients with severe vaginal bleeding were analyzed, too.Results There was change in ultrasonographic results after treatment in all patients.Combined with serumβ-hCG, B-ultrasonic inspection could be used to evaluate therapeutic effect.There were 5 cases with vaginal bleeding≥200mL in the course of CSP, including 2 cases of pregnancy sac type and 3 cases of mass type.The mass progressively grew found by B-ultrasonic reexamination.For cases complicated with large bleeding, uncontrolled vaginal bleeding occurred easily. Conclusion B-ultrasonic inspection can be used to evaluate the therapeutic effect of medication.If B-ultrasonic inspection indicates growing of mass or rich blood flow around conceptus, the CSP patients will suffer severe vaginal bleeding easily.