剖宫产瘢痕妊娠的个体化治疗

Individualized treatment of cesarean scar pregnancy

目的:探讨剖宫产瘢痕妊娠(CSP)的个体化综合治疗方法。方法:2006年12月～2012年12月,根据剖宫产史、妊娠表现、经阴道超声诊断,确诊CSP患者38例。按血β-人绒毛促性腺激素(β-HCG)水平、妊娠囊与子宫切口的关系及局部血运情况,26例首选甲氨蝶呤(MTX)化疗,10例首选清宫术,2例首选手术治疗,结果:26例经MTX化疗后,15例患者仅保守治疗未行清宫术,11例待血HCG下降80%～90%、病灶血流减少或消失后行病灶清除术;10例患者首选清宫术,均痊愈出院。结论:CSP的治疗应依据血β-HCG水平和病灶部位、表面肌层厚度、血供及阴道流血情况,选择个体化综合治疗方式。

Objective：To investigate the suitable measures of treatment of cesarean scar pregnancy（CSP）.Methods：From December 2006 to December 2012,38 cases were diagnosed as CSP on the basis of the history of cesarean section and the manifestations of pregnancy by transvaginal ultrasound.According to the blood level of β-HCG,26 cases received a protocol of methotrexate.10 cases underwent curettage and laparoscopic monitoring if necessary.2 patients preferred surgical treatment.Results：15 patients from 26 patients had been only conservative treatment after MTX chemotherapy.When β-HCG decreased 80%~90% and mass blood flow reduced or disappeared,11 cases administered focal resection and discharged.10 patients preferred curettage was discharged.Conclusion：CSP treatment should accord level of serum β-HCG,lesion site,surface muscle thickness,blood supply,and vaginal bleeding to choose individualized treatment.