CAJ | 학술논문

目的：探讨剖宫产瘢痕妊娠（CSP）个体化治疗临床方案，分析不同治疗方法的临床结局。方法经阴道超声、彩色多普勒超声和血绒毛促性腺激素检查确诊 CSP 患者79例，采用腹腔镜监护下或 B 超监护下清宫术（57例）、腹腔镜下或经腹妊娠病灶切除术（14例）、子宫动脉栓塞术（2例）和 MTX ＋息隐药物保守（6例）方法进行治疗，分析治疗效果。结果79例患者均完成手术或药物治疗，子宫切除率1．27％，治愈率100％。腹腔镜监护下清宫组与 B 超监护下清宫组术前一般情况及术中出血量差异无统计学意义，住院天数 B 超监护下清宫术组较腹腔镜监护下清宫术组长（P ＜0．05）；腹腔镜下妊娠病灶切除组与经腹妊娠病灶切除组术前一般情况及住院天数差异无统计学意义，术中出血量腹腔镜组大于开腹组（P ＜0．05）。结论根据病情选择个体化治疗方案能改善 CSP 患者的疗效和预后，病灶超声诊断对选择合理的手术方式有指导意义。
목적：탐토부궁산반흔임신（CSP）개체화치료림상방안，분석불동치료방법적림상결국。방법경음도초성、채색다보륵초성화혈융모촉성선격소검사학진 CSP 환자79례，채용복강경감호하혹 B 초감호하청궁술（57례）、복강경하혹경복임신병조절제술（14례）、자궁동맥전새술（2례）화 MTX ＋식은약물보수（6례）방법진행치료，분석치료효과。결과79례환자균완성수술혹약물치료，자궁절제솔1．27％，치유솔100％。복강경감호하청궁조여 B 초감호하청궁조술전일반정황급술중출혈량차이무통계학의의，주원천수 B 초감호하청궁술조교복강경감호하청궁술조장（P ＜0．05）；복강경하임신병조절제조여경복임신병조절제조술전일반정황급주원천수차이무통계학의의，술중출혈량복강경조대우개복조（P ＜0．05）。결론근거병정선택개체화치료방안능개선 CSP 환자적료효화예후，병조초성진단대선택합리적수술방식유지도의의。
Objective To discuss the individualized therapy of caesarean scar pregnancy (CSP) and corresponding clinical overcomes.Methods A total of 79 patients were included in the current study, who were diagnosed with caesar-ean scar pregnancy (CSP) through transvaginal ultrasonography, color doppler ultrasound and human chorionic gonado-tropin.They were treated with curettage of the uterine cavity guided by ultrasonography or laparoscopy (57 patients), laparoscopic or transabdominal excision of scar tissues (14 patients), uterine arterial embolization (2 patients) or a com-bination of MTX and mifepristone (6 patients).Then, the therapeutic effectiveness was analyzed.Results All patients underwent surgery or drug therapy and cured, with a rate of hysterectomy of 1.27%.No statistical difference was ob-served as to the general condition before surgery and the amount of bleeding during surgery between patients receiving cu-rettage of the uterine cavity guided by ultrasonography or laparoscopy.The duration of hospitalization was longer for pa-tients guided by ultrasonography than those by laparoscopy (P <0.05).Patients who underwent transabdominal excision of scar tissues produced a higher amount of bleeding than those treated with laparoscopic excision (P <0.05), with no significant difference as to the general condition before surgery and the duration of hospitalization.Conclusion Based on the condition of each patient, individualized therapy can improve the effectiveness and prognosis in CSP patients.The ul-trasonographic diagnosis is instructive for determination of a rational operation.