剖宫产术后疤痕妊娠19例临床分析

Clinilal Analysis of 19 Cases with Cesarean Scar Pregnancy

目的探讨剖宫产术后疤痕妊娠的治疗方法.方法回顾性分析2010年1月至2012年6月收治的19例剖宫产术后疤痕妊娠的临床资料.结果 2例患者行子宫次全切除术,9例患者行开腹疤痕妊娠组织剔除术+疤痕缺陷修补术,4例患者行经超声引导下局部注入甲氨喋呤+口服米非司酮治疗,其余4例患者行药物治疗(甲氨喋呤+米非司酮)联合子宫动脉栓塞术后,B超引导下吸宫术.结论早期诊断疤痕妊娠,并对不同类型的病人给予不同的治疗方法,对保留患者的生育功能,减轻经济及心理负担有益.治疗方法的选择主要取决于孕囊与子宫疤痕的关系、血β-人绒毛膜促性腺激素(β-HCG)的值以及妊娠包块的血流情况.

Objective To explore the methods of treatment for cesarean scar pregnancy.Methods The clinical data of 19 cases with cesarean scar pregnancy admitted between January 2010 and June 2012 were analyzed retrospectively.Results 2 cases were operated with subtotal hysterectomy;9 cases received laparotomy treatment of scar tissue excision and neoplasty;4 cases received local injection with methotrexate(MTX) under the ultrasound guidance,with the addition of mifepristone orally at the same time;4 cases had the drug treatment(MTX and mifepristone),which was combined with uterine artery embolization,following uterine curettage with ultrasound guidance.Conclusion Early diagnosis of scar pregnancy and individual therary to diffeient patients are beneficial to retain reproductive function and reduce the economic and psychological burden in patients.The choice of treatment depends on the relationship between the gestational sac and the uterine scar,β-HCG of serum and mass of blood flow.