21例剖宫产子宫切口瘢痕部位妊娠临床病例分析

Diagnosis and management of 21 cases of cesarean scar pregnancy

目的探讨剖宫产子宫切口瘢痕部位妊娠（cesarean scar pregnancy，CSP）的早期诊断和治疗。方法收集1995年11月至2005年11月共十年间复旦大学附属妇产科医院收治的所有病例的临床资料，共21例。根据超声检查，血hCG的水平确诊，分析其发病年龄、孕周、症状、治疗方式及预后。结果患者平均年龄33岁（26-44岁），均为1次剖宫产术史，此次妊娠距离前次剖宫产的时间为8个月～18年，平均孕龄为47d（36～70d）。16例（76．2％）患者主诉阴道流血，其中6例（28．6％）伴有腹痛。治疗方式包括单独或联合应用氨甲蝶呤（methotrexate，MTX）全身或局部给药、子宫动脉栓塞术、介入化疗、宫腔镜下病灶切除术、开腹子宫病灶切除术、刮宫术等。所有病例均保守治疗成功，保留了生育功能。平均住院天数为22d（9～39d）。结论CSP的发病呈上升趋势，早期发现多可保守治疗。MTX能有效终止妊娠，介入化疗和子宫动脉栓塞术联合刮宫术是有效的治疗手段。

Objective To study the early diagnosis and treatment of cesarean scar pregnancy （CSP）. Methods During a 10-year period from Nov. 1995 to Nov. 2005, 21 patients were diagnosed as CSP and treated conservatively to preserve fertility in Obstetrics and Gynecology Hospital, Fudan University. Gestational age, symptoms, methods of treatment and prognosis were retrospectively analyzed. Results The average age of the 21 women was 33（26-44）. The interval from the last cesarean section was 8 months to 18 years. The average gestational age was 47 d. Among the 21 women, 76. 2% （16 cases）complained of vaginal bleeding and 28. 6% （6 cases） experienced abdominal pain. The average period of hospitalization was 22 d（9-39 d）. The methods of treatment included systemic or local methotrexate administration, uterine artery embolization, interventional chemotherapy, hysteroscopy and lesion excision, laparotomy and excison of lesion, dilatation and curettage. Fertility was preserved for all patients. Conclusion CSP is more common than before and MTX, interventional chemotherapy and uterine artery embolization combined with curettage are effective in conservative treatment of CSP.