剖宫产术后子宫瘢痕部妊娠诊治探讨

Study on clinical diagnosis and treatment for cesarean scar pregnancy

目的探讨剖宫产瘢痕妊娠的发病机制、诊断和治疗方法。方法回顾性分析2000年1月-2011年1月我院收治的129例剖宫产瘢痕妊娠患者的临床资料。结果129例患者中，一次剐宫产史98例，二次剖宫产史31例。所有患者阴道超声或彩色多普勒超声检查，结合血β-hCC水平确诊。35例患者单纯药物治疗，成功率100％。药物加手术治疗38例，33例成功，出血量15-130ml，平均45ml，成功率86．8％；5例因CSP破裂阴道大出血行全子宫切除术。子宫动脉栓塞术（UAE）治疗56例，50例成功，成功率89．3％。住院时间5-20天，治疗后15-30天 β-HCG降至5mlU／ml以下；6例因子宫血管畸形导致刮宫时大出血，行手术治疗。结论剖宫产瘢痕妊娠患者应结合妇科检查及辅助检查以早期诊断，根据患者情况予以个体化治疗，可获得较好疗效．

Objective To explore the pathogenesis, early diagnosis and individualized treat- ment for cesarean scar pregnancy. Methods The clinical data of 129 cases with cesarean scar pregnancy from January 2000 to January 2011 were analyzed retrospectively. Results 98 patients had history of cesarean delivery once, and 31 patients twice. All patients were diagnosed as asymptomatic cesarean scar pregnancy definitely by vaginal ultrasound and color Doppler ultrasonography, combined with serum β - hCG level diagnosis. 35 cases were treated with drug, with the success rate of 100%, 38 cases were treated with drug plus operation, 33 cases were successful,, bleeding vohlme of about 15 - 130 ml, average 45 ml, with the success rate of 86.8%. 5 cases received total hysterectomy because of CSP rupture vagina bleeding 1 month later. 56 cases were treated by Uterine artery embolization （UAE）, 50 cases were successful, wilh the success rate of 89.3%. Hospitalization time is 5 - 20 days, β -hCG decreased to 5 mIU / ml after 15 -30 days below. 6 cases with pregnancy for 7 weeks were treated with surgical operation because of uterine vascular mallfrmalions causing henmrrhage.Conclusion The early diagnosis is important by gynecologic and auxiliary examination, the therapeutic effect of individualized treatment is good.