剖宫产术后子宫瘢痕妊娠的早期诊断与治疗(附9例报告)

Early Diagnosis and Treatment of Cesarean Scar Pregnancy:9 Cases Report

目的探讨剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)的早期诊断及治疗方法。方法回顾性分析9例CSP患者的临床资料。所有患者就诊时均有停经并尿HCG阳性,其中4例伴阴道出血,2例伴下腹痛,3例无自觉症状。9例均经妇科彩超检查确诊:2例门诊彩超确诊为CSP;7例门诊黑白B超误诊为宫内早孕行人流术,其中术中阴道大出血3例,术后阴道少量出血不止4例,最终经彩超检查确诊。结果本组行子宫动脉栓塞(uterine arterial embolization,UAE)+清宫术2例;UAE+甲氨蝶呤+米非司酮保守治疗后行清宫术3例,其中1例术后持续阴道出血并血HCG无明显下降而再行子宫瘢痕部切除术;3例应用甲氨蝶呤+米非司酮保守治疗后血HCG下降至正常而未行清宫术;1例直接行子宫瘢痕部切除术。所有病例均痊愈出院并随访7～12月,无并发症发生。结论 CSP临床少见且易误诊误治;彩超在其早期诊断方面有重要参考价值;应用UAE和(/或)甲氨蝶呤+米非司酮药物治疗并结合清宫术是治疗CSP的有效方法。

Objective To discuss the early diagnostic methods and treatment strategies of cesarean scar pregnancy（CSP）.Methods The clinical data of 9 CSP cases were analyzed retrospectively.All cases were found menelipsis and Human chorionic gonadotropin（HCG） increasing in urine.Among them,colporrhagia was present in 4 cases,hypogastralgia in 2,and no rational symptom in 3.The total of 9 patients got final diagnosis of CSP by pelvic Doppler color ultrasonography.Results The treatment strategies were as follows：Uterine arterial embolization（UAE） and curettage was performed in 2 cases;UAE,medication of MTX and mifepristone and curettage in 3 cases,and out of them,1 case received cesarean scar excision of uterus because of last vaginal bleeding and no decreasing of blood HCG;only medication of MTX and mifepristone in 3 cases;cesarean scar excision in 1 case.All patients cured and discharged from hospital.No complication was found during the 7 to 12 months follow-up.Conclusions CSP is uncommon,and so it can be misdiagnosed easily;Color ultrasonography can play an important role in its early diagnosis.Followed by curettage,UAE or combined with medication of MTX and mifepristone is an effective treatment for CSP.