齐鲁医院分型诊治78例子宫瘢痕妊娠的临床观察

Clinical Observation of 78 Cases of Cesarean Scar Pregnancy Diagnosed and Treated by Typing in Qilu Hospital

摘要: 目的：探讨齐鲁医院分型在治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床疗效。方法：选取2020年1月至2020年12月在山东省临沂市人民医院妇科收治的78例CSP患者的临床资料，依据齐鲁医院分型诊治：分为I型组、IIa型组、IIb型组、IIIa型组、IIIb组及IIIc型组。分析各组患者的一般资料、临床疗效。结果：78例CSP患者均经我院经阴道超声进行明确诊断，依据齐鲁医院分型对于CSP患者进行诊治：I型29例，IIa型21例，IIb型6例，IIIa型10例，IIIb型11例，IIIc型1例。在CSP不同分型中年龄、距离上一次剖宫产时间比较，差异均无统计学意义(P > 0.05)。不同分型中停经时间、剖宫产次数、术前β-HCG水平比较，差异有统计学意义(P < 0.05)。74例CSP患者在术后2月内月经复潮，比例为94.87%，3例CSP患者需要二次手术，3例术中需要中转手术方式，总体治疗成功率为92.3% (72/78)。结论：对于CSP患者，依据齐鲁医院分型进行诊治，手术均获得了较好的治疗效果，无因术中大出血而切除子宫。此分型适用于临床，简便可行，能够对患者的病情充分地评估，推荐的治疗方案，成功率高，并发症少，值得进一步应用于临床及推广。

Abstract: Objective: To investigate the clinical efficacy of Qilu Hospital classification in the treatment of cesarean scar pregnancy (CSP). Methods: The clinical data of 78 patients with CSP admitted to the Department of Gynecology, Linyi People’s Hospital of Shandong Province from January 2020 to December 2020 were selected and divided into type I group, type IIa group, type IIb group, type IIIa group, and type IIIb IIIc group according to the classification of Qilu Hospital. The general data and clinical efficacy of patients in each group were analyzed. Results: Seventy-eight patients with CSP were diagnosed by transvaginal ultrasonography in our hospital. The patients with CSP were diagnosed and treated according to Qilu Hospital classification: 29 cases of type I, 21 cases of type IIa, 6 cases of type IIb, 10 cases of type IIIa, 11 cases of type IIIb, and 1 case of type IIIc. There were no significant differences in age or time from the last cesarean section among the different types of CSP (P > 0.05). There were significant differences in menopause time, number of cesarean sections, and preoperative β-hCG levels among different types (P < 0.05). Seventy-four CSP patients had resumption of menses within 2 months after surgery, with a proportion of 94.87%, 3 CSP patients required a second operation, and 3 patients required intraoperative conversion to surgical methods, with an overall treatment success rate of 92.3% (72/78). Conclusion: For patients with CSP, according to the classification of Qilu Hospital, the operation obtained a better therapeutic effect, and no uterus was removed due to intraoperative massive hemorrhage. This classification is suitable for clinical use, simple and feasible, and can fully evaluate the patient’s condition. The recommended treatment has high success rate, with fewer complications. It is worthy of further clinical application and promotion.