剖宫产瘢痕妊娠并胎盘植入的临床研究(附12例分析)

Clinical analysis of 12 cases of cesarean scar pregnancy with placenta increta

目的探讨剖宫产瘢痕部位妊娠(cesarean scar pregnancy,简称CSP)胎盘植入子宫瘢痕的病因、病理、诊断、处理及预防措施。方法回顾分析该院2004年1月～2009年4月12例剖宫产瘢痕处妊娠患者的临床资料并结合文献加以分析。结果1600例瘢痕子宫妇女中,剖宫产瘢痕妊娠并胎盘植入12例,发生率为0.75%。12例中10例子宫切除,占83.33%,2例局部子宫壁组织切除加宫腔内纱布填塞保守治疗,保留了子宫。无产妇死亡。结论降低剖宫产率是减少该并发症的根本所在,产前早期诊断是改善其预后的关键。剖宫产瘢痕妊娠并胎盘植入术中出血凶猛采取止血措施无效时应果断行子宫切除术,重视个体化手术方式的选择。

【Objective】To explore the etiology, pathology, diagnosis, treatment and preventive measures of cesarean scar pregnancy with placenta.【Methods】12 cases of cesarean scar pregnancy during the 5-year period from January 2004 to April 2009 were analyzed retrospectively and the relative literature was reviewed. 【Results】Of the 1 600 cesarean scar pregnancies, placenta increta occurred in 12 cases, with an incidence rate of 0.75%. Ten out of 12 （83.33%） cases received emergency hysterectomy. Two cases were treated with uterine compression sutures and intrauterine pack with gauze for hemostasis. There were no maternal deaths. [ Conclusions ] Reducing cesarean section rate is essential to reduce the incidence of these complications of cesarean scar pregnancy. Early prenatal diagnosis of placenta accreta is the key to improve their prognosis. When placenta accreta is suspected a strategy to minimize blood loss during surgery should be discussed by a muhidisciplinary team. Emergency hysterectomy is usually inevitable for cases with serious hemorrhage. Management plan should be individually tailored.