剖宫产子宫切口瘢痕部位妊娠临床分析

Clinical analysis of cesarean scar pregnancy

目的探讨剖宫产术后子宫瘢痕部位妊娠的临床表现、诊断、治疗及预后。方法回顾性分析9例子宫瘢痕部位妊娠患者的临床资料,包括临床表现、发生子宫瘢痕部位妊娠距前次剖宫产术的时间、辅助检查、治疗方法及预后。结果患者发病距前次剖宫产妊娠时间2～25年;孕龄:早孕6例,中孕2例,晚孕1例。治疗方法:氨甲喋呤全身或局部化疗2例;宫腔镜病灶电切3例;吸宫术1例;开腹病灶切除1例;剖宫取胎术3例;子宫次全切除3例。结论随着剖宫产率的升高,子宫瘢痕部位妊娠的发病率明显上升,是剖宫产术后严重的并发症。二维超声、宫腔镜检查、MRI、血β-HCG对CSP的诊断和鉴别诊断有很高的价值。氨甲喋呤全身和局部用药后再行吸宫术有效,开腹行病灶局灶切除安全,病灶<5cm、局限在浅肌层宫腔镜电切安全有效。

Objective To discuss the diagnosis,treatment and prognosis of cesarean scar pregnancy. Methods 9 cases of CSP were analyzed retrospectively,and the clinical manifestations,CSP place time from the previous cesarean section,auxiliary examination,treatment and prognosis of these 9 women were reviewed. Results The interval between CSP and the last cesarean scar time to pregnancy were 2-25 years. Gestational age：6 cases of early pregnancy,in mild pregnancy 2 cases,1 case of late pregnancy. Treatment of these cases including methotrexate systemic or local chemotherapy（2 cases） ,hysteroscopic resection lesions（3 cases） ,curettage（1 case） ,laparotomy excision（1 case） ,cesarean section（3 cases） ,hysterectomy（3 cases） . Conclusion The incidence of CSP was significantly higher following of the higher cesarean section rate,which was the serious complication after cesarean section. Two-dimensional ultraso und,hysteroscopy,MRI,blood β-HCG had a high value for the diagnosis and differential diagnosis of CSP. Curettage after MTX systemic and local drug was effective. It was safe removal focal lesions from abdominal safety line,while hysteroscopic surgery was safe and effective for lesions smaller than 5 cm,confined to the superficial muscle layer.