剖宫产术后子宫瘢痕妊娠10例分析

Scar pregnancy after sesarean section: report of 10 cases

目的探讨剖宫产术后子宫瘢痕妊娠(CSP)发生原因、临床表现及处理,以提高对该病的认识和诊治水平。方法对10例CSP患者的临床资料进行回顾性分析。结果 3例采用超声引导下经阴道妊娠囊内注射甲氨蝶呤(MTX)治疗,2例有效,1例因血β-HCG下降不满意,开腹探查行局部病灶切除术;6例在刮宫术中大量出血,3例迅速行子宫动脉栓塞术(UAE)有效止血,并于栓塞后24 h B超监视下行清官术;2例予以纱布填塞宫腔压迫止血,超声引导下经腹局部病灶注射MTX(50mg/m^2),监测血β-HCG下降接近正常,在超声引导下清官;另1例药物治疗不满意而选择开腹病灶切除术。外院转入1例因阴道出血,生命体征不平稳,在抗休克、输血、输液同时行急诊子宫切除术。结论对于有剖宫产史的早孕妇女应进行常规阴道超声检查;考虑为CSP的患者应避免盲目刮宫或药物流产;子宫动脉栓塞、MTX保守及手术治疗是可选择的有效的治疗方法。

Objective To explore the cause, clinical manifestations and treatment of the scar pregnancy （CPS）, to enhance the awareness of the disease, diagnosis and treatment. Methods The clinical data of 10 cases of CPS were analyzed retrospectively. Results Of 3 cases treated by the vagina injection of methotrexate （MTX） under the supersonic guidance,2 cases were effective and 1 ease received open surgery and lesion resection due to no satisfying serum β-HCG decline, of 6 cases of heavy bleeding in the curettage, 3 cases received the rapid uterine artery embolization （UAE） and hemostasis was effective, and received uterine curettage in 24 hours after embolization under the supersonic guidance; 2 cases received uterine cavity pressure with gauze packing to stop bleeding, the abdominal local lesion injection of MTX （50 mg/m^2 ） under the supersonic guidance, and received lesion resection under supersonic guidance after serum β-HCG was close to normal; the other one cases received open surgery and lesion resection due to poor drug treatment effect, one cases from outside hospital with vaginal bleeding and unstable vital signs, received emergency hysterectomy in the condition of anti-shock, blood transfusion and infusion at the same time. Conclusion Women with a history of cesarean section in early pregnancy should be routinely performed the conventional vagina supersonic examination; the patients with suspected CPS should avoid blind curettage or drug abortion;uterine artery embolization, MTX conservative treatment and surgical treatment are effective alternative treatments.