剖宫产切口瘢痕部位妊娠临床治疗探讨

Approach to the Therapy for the Caesarean Scar Pregnancy

目的 探讨剖宫产术后子宫切口瘢痕妊娠（caesarean scar pregnancy,CSP）的治疗方法.方法 对笔者医院2013年6月～2014年6月收治的205例CSP的临床资料进行回顾性分析,患者平均年龄32.98±4.56岁,其中有189例手术治疗病例,本研究主要对这189例进行分析.结果 189例手术病例中,111例行宫腔镜下清宫术,70例行超声引导下清宫术,8例行腹腔镜下剖宫产瘢痕切除术,全部治愈,无子宫切除病例.宫腔镜下手术可以帮助术者看清病灶的方位,利于妊娠物清除;超声监测下的手术既简便又经济;腹腔镜手术更适于外生型的CSP患者,可以降低手术风险,有效预防子宫穿孔的发生,但住院费用较前两者高,住院时间也明显延长.结论 CSP应早诊断、早治疗,根据不同的病情选择个性化的治疗方案,遵循创伤小、安全性高、治疗彻底、恢复快的原则,降低子宫切除的风险,保留生育功能,提高患者的生活质量.

Objective To explore the treatment of caesarean scar pregnancy （CSP）. Methods We analyzed retrospectively 205 cases of CSP, who were treated in our hospital from June 2013 to June 2014. The average age of the patients was （32.98 ± 4.56） years old. Among them,189 patients had surgical operation, we analyzed these cases. Results Among the 189 patients, 111 patients had cu- rettage under hysteroscopy,70 patients had curettage under ultrasonography,8 patients had cesarean scar resected laparoscopically. All the patients were cured without hysterectomy. Hysteroscopy can help us identify the range of affected tissue, and give us a clear view to clean the pregnancy tissue. The advantage of curettage under ultrasonography is simple and inexpensive. Applying laparoscopic surgery to the patients whose CSP are exogenous can reduce the operation risk and prevent uterine from perforation effectively. But laparoscopic surgery is costly and prolongs hospitalization. Conclusion Early diagnosis and treatment of CSP is very important. Treatment options should be personalized according to different clinical situation. Minimal invasion, completely treated, quick recovery, reducing the risk of hysterec- tomy, fertility preserving and improving the quality of life of the patients, are the principle we pursue for.