剖宫产术后子宫瘢痕妊娠的诊治分析

Clinical analysis of cesarean scar pregnancy

目的探讨剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)的临床特点和治疗方法。方法回顾性分析22例剖宫产术后子宫瘢痕妊娠患者的临床资料。结果 14例(63.64%)出现无痛性阴道流血,18例(81.82%)在人工流产术中大量阴道流血或人工流产/药物流产术后阴道流血淋漓不尽,患者均通过阴道B超或彩超确诊。治疗方法包括药物治疗(13例),药物治疗+B超引导下清宫术或宫腔镜下病灶切除术(9例)。药物治疗和药物加病灶去除手术治疗患者治疗后阴道流血时间、人绒毛膜促性腺激素(human chorionic gonadotrophin,HCG)下降至正常水平时间差异无统计学意义(P>0.05)。患者均治愈,其中1例治愈后1年再次发生CSP。结论剖宫产术后子宫瘢痕妊娠比较少见,临床表现不典型,易发生误诊误治。超声检查是有效的诊断方法。治疗方案应根据患者病情,进行个体化的综合治疗。

Objective To study clinical characteristics and treatment of cesarean scar pregnancy.Methods Clinical data of 22 patients with cesarean scar pregnancy were analyzed retrospectively.Results Among 22 cases,14 cases（64%） presented with painless vaginal bleeding,18 cases（82%） presented heavy vaginal bleeding during curettage or irregular vaginal bleeding after induced or drug abortion.All patients were diagnosed by trans-vaginal B-ultrasound or color ultra-sonography.Treatment for the patient included medical therapy（13 cases）,medical therapy plus curettage under B-ultrasound（4 cases）,or medical therapy plus hysteroscopy（5 cases）.No significant difference was found on the duration of vaginal bleeding after treatment and serum hCG resolution time between medical therapy and medical therapy plus curettage or hysteroscopy（P0.05）.All of the 22 cases fully recovered,while 1 case got CSP again 1 year after recovery.Conclusion cesarean scar pregnancy is one of the rarest forms of ectopic pregnancy.Trans-vaginal ultrasound provides the high diagnostic accuracy.Early diagnosis can offer treatment options of avoiding uterine ruptures and hemorrhage.Management plan should be individually tailored.