剖宫产术后子宫瘢痕部位妊娠41例临床分析

CESAREAN SCAR PREGNANCY:CLINICAL ANALYSIS OF 41 CASES

目的探讨剖宫产术后子宫瘢痕部位妊娠(cesarean scar pregnancy,CSP)的诊治方法。方法回顾性分析2004年1月—2010年4月河北医科大学第二医院收治的41例CSP患者的临床表现及治疗效果。结果 41例CSP患者,均有停经史,29例(70.7%)有阴道出血,41例均经彩超确诊。非手术治疗成功33例(80.5%),行手术治疗8例(19.5%),其中3例行病灶切除,5例行子宫切除术。结论超声是诊断CSP的重要方法,病情稳定者肌内注射甲氨蝶呤后行刮宫术是治疗的有效方法,未明确诊断前,切忌盲目宫腔操作。

Objective The aim of the article was to analyze the diagnosis and treatment of cesarean scar pregnancy. Methods The clinical data of 41 patients with cesarean scar pregnancy from January 2004 to April 2010 in the Second Hospital of Hebei Medical University was analyzed retrospectively. Results All of the 41 patients （ 100% ） had menolipsis history, 29 of which （70.7%） had clinical manifestations such as colporrhagia. All of them （ 100% ） received transvaginal ultrasound and colour flow Doppler which provided a high diagnostic accuracy. Thirty three patients （80.5 % ） were treated by conservative medical treatment successfully. Eight patients （19. 5% ） received surgical treatment, 3 of them underwent a wedge excision of the gestational mass, the other 5 patients underwent hysterectomy. Conclusion The transvaginal ultrasound and colour flow Doppler play an important role in diagnosing pregnancy with a cesarean delivery scar. Combined systemic methotrexate （MTX） and dilation and curettage （D＆C） are used as a primary therapy in the patients diagnosed early. A clear diagnosis should be made before giving appropriate treatment.