剖宫产瘢痕妊娠25例临床分析

Clinical analysis of 25 cases with cesarean scar pregnancy

目的探讨剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的诊断及治疗方法。方法对该院2007～2011年收治的25例CSP患者临床资料进行回顾性分析。结果 25例患者中6例因停经后阴道流血就诊,10例因停经后怀疑早孕来就诊时,B超检查而确诊。9例因误诊为宫内早孕而行人流,药流清宫术,术中发生阴道大出血行B超检查诊断为子宫瘢痕妊娠,急诊行子宫动脉甲氨蝶呤(MTX)灌注+栓塞,迅速有效的控制了阴道流血并减少了术中出血,均成功保留了生育功能。16例予甲氨蝶呤全身用药保守治疗,6例因全身用药效果不佳改用甲氨蝶呤局部用药,9例予甲氨蝶呤治疗患者联合清宫术。15例甲氨蝶呤保守治疗患者治疗成功,仅1例失败开腹行局部病灶切除术。结论超声是诊断CSP的简便可靠方法。MTX作为先期治疗,联合清宫术是治疗CSP的一种具有临床价值的保守治疗方法。子宫动脉甲氨蝶呤灌注+栓塞可以迅速止血,并有效杀灭妊娠胚物,降低子宫切除丧失生育功能的风险,是CSP并发大出血患者适宜的处理方案。

【Objective】To explore the cesarean scar pregnancy（CSP） diagnosis and treatment.【Methods】Clinical data of 25 cases of CSP patients from 2007 to 2011 were retrospectively analyzed.【Result】Among them,6 cases of vaginal bleeding after menopause saw a doctor,10 cases of postmenopausal were doubted pregnancies by ultrasound examination and diagnosis.9 cases of misdiagnosed as palace pregnancies and done people or medicine flow,all of them were happened vaginal hemorrhage.In the operation,emergency lined uterine artery perfusion of methotrexate and embolism,quickly effective controlled of the vaginal bleeding,all successful retained the reproductive function.16 cases to methotrexate systemic medicine conservative treatment,6 cases of systemic drug effects were not good to switch to local administration,9 cases with methotrexate therapy combined with the curettage.15 cases methotrexate therapy treatment succeed,only 1 case was done local lesion resection.【Conclusion】Ultrasonic diagnosis of CSP is simple and reliable method.MTX as early treatment,combined the curettage is a kind of clinical value of the conservative treatment.Uterine artery perfusion of methotrexate and embolism can quickly stop bleeding,and effectively kill the balloon pregnancy embryo content,reduce the hysterectomy loss risk of reproductive function,is appropriate treatment scheme for the CSP concurrent hemorrhage patients.