目的 比较剖宫产切口瘢痕妊娠不同术式的临床疗效,探讨更精准、更优越、更经济、风险更小的治疗方案。方法 110例剖宫产切口瘢痕妊娠患者来自2013年1月至2016年4月在安徽省妇幼保健院住院病例,分别采用经阴道子宫瘢痕妊娠物切除术(术式A)、子宫动脉栓塞+清宫术(术式B)、宫腔镜+清宫术(术式C)进行治疗,以手术时间、出血量、并发症、术后住院时间及住院费作为观察指标,采用t检验或Fisher确切概率法进行统计分析,评估不同手术方式的临床疗效。结果 术式A、术式B和术式C术中平均出血量分别为103.8 ml、48.8 ml、283.3 ml,住院时间分别7.3 d、13.0 d、7.0 d,手术并发症发生率分别为1.7%、0.0%、13.3%,三种术式间差异均具有统计学意义(F_出血量=3893.36,P=0.000;F_住院时间=1473.80,P=0.000;确切概率P＜sub>并发症=0.025)。术式B术中出血量少、并发症发生率低,但手术时间和住院时间长、手术费用高;术式A和术式C住院时间短、手术费用低,但术中出血量多、并发症发生率高。结论 三种手术方式均为有效的治疗手段,但在出血量、住院时间、并发症等观察指标上各有优劣,应根据患者个体情况选择更合适的治疗方式减少患者的病痛,同时减轻患者的经济负担。

Objective To explore more accurate, more superior, more economical and less risk treatment plan for cesarean scar pregnancy by comparing the clinical effects of different surgical methods. Methods There were 110 cases of cesarean scar pregnancy collected in Anhui women and children health care hospital from January 2013 to April 2016 were selected and treated by transvaginal uterine scar pregnancy resection (operation A), uterine artery embolization plus uterine curettage (operation B) and hysteroscopy plus uterine curettage (operation C). The operation time, bleeding volume, complications, postoperative hospitalization time and hospitalization expenses were taken as the observation indexes. T test or Fisher exact test method was used to analyze the operation time, bleeding volume, complication, postoperative hospital stay and hospitalization cost of these cases. Results Intraoperative bleeding volume of the three operative methods were 103.8 ml, 48.8 ml, 283.3 ml, respectively. Postoperative hospital stay were 7.3 d, 13.0 d, 7.0 d, respectively. Complication occurring rates were 1.7%, 0.0%, 13.3%, respectively. There were significantly different between the three operative methods (P value all<0.05). The operation B had the advantages of less bleeding, low complications, and the disadvantages of the long operation time and hospital stay, and high cost. The other two operative methods had the advantages of short hospital stay and low cost, but had the disadvantages of more intraoperative bleeding and higher complications. Conclusion The three kinds of operation were all effective treatment methods, but each had its own merits and demerits in the amount of bleeding, length of stay, complications and other observational indicators.