不同类型子宫瘢痕妊娠手术治疗方法回顾性研究

A retrospective study on surgical treatment for different types of cesarean scar pregnancy

目的探讨不同类型剖宫产子宫瘢痕部位妊娠（CSP）患者手术治疗方法的选择。方法回顾性分析该院2010年6月~2011年6月诊治的CSP患者35例,根据孕囊生长的方向分为Ⅰ型和Ⅱ型,分别采用子宫动脉栓塞（UAE）＋B超监测下清宫,子宫动脉栓塞＋妊娠病灶切除＋子宫瘢痕修补术。结果 35例患者中Ⅰ型20例,Ⅱ型15例。Ⅰ型CSP采用UAE＋B超监测下清宫,UAE后清宫以24~48 h为宜,术后监测血β-HCG恢复正常时间为平均（17.05±4.78）d,平均术后（35.00±2.40）d月经来潮,9例月经异常患者中,8例患者行宫腔镜检查发现子宫切口缺陷。Ⅱ型CSP行UAE＋妊娠病灶切除＋子宫瘢痕修补术具有治疗,术后监测血β-HCG恢复正常时间为平均（11.13±3.78）d,平均术后（34.00±3.40）d月经来潮。15例患者均恢复月经,13例无异常阴道出血,其中10例患者术前经期时间延长术后恢复正常,2例患者仍经期时间延长,2例患者行宫腔镜检查发现子宫切口缺陷。结论对于CSP患者,需要根据患者CSP类型、子宫峡部前壁肌层厚度及有无生育要求等综合分析,但对于两类CSP尤其是Ⅰ型CSP在术前如何确诊子宫切口缺陷及子宫瘢痕修补术指征仍须大样本进一步随访研究,以减少术后复发。

[ Objective] To evaluate the different surgical treatments for two types of cesarean scar pregnancy. [Methods] 35 patients with type I or 11 CSP from June 2010 to June 2011 were reviewed retrospectively, surgically treated by UAE ＋Curettage under B ultrasound monitoring and UAE ＋ laparotomy excision with repairing of the scar lesion. [Results] 20 patients with type I CSP had normal menstruation at （35±2.4）days and serum β-hCG returned to normal at （17.05±4.78）days after the operation evenly. 8 of 9 patients with abnormal menstruation were identified as cesarean section scar defects with hysteroscopy. 15 patients with type 11 CSP had normal menstruation at （34±3.4）days and serum β-hCG returned to normal at （11.13＋3.78）days after the operation evenly. 2 patients with abnormal menstruation were identified as cesarean section scar defects with hysteroscopy, 10 of 13 patients recovered normal menstruation had menostaxis before the operation. [ Conclusions ] For CSP patients, especially for the type II CSP, the type of CSP, uterus isthmus anterior wall myometrial thickness and fertility requirements, preoperative diagnosis of uterine incision defects can be analyzed and whether uterine scar should be repaired still need further follow-up study of a large sample to reduce the recurrence.