剖宫产术后子宫瘢痕妊娠57例临床研究

Clinical study on 57 cases with caesarean scar pregnancy

目的探讨剖宫产术后子宫瘢痕妊娠（CSP）的治疗方法及临床处理中可能出现的问题。方法对2011年1月至2013年1月就诊于河北大学附属医院并符合CSP诊断标准的57例患者的临床资料进行回顾性分析。其中12例行清官术（清宫组），22例行子宫动脉栓塞术（栓塞组），8例行开腹病灶清除术（开腹组），15例行阴式病灶清除术（阴式组）。结果（1）清官组、栓塞组、开腹组、阴式组治疗成功率分别为12／12、86％（19／22）、7／8、13／15。（2）清官组中位术中出血量为20ml（17～28m1）、住院时间为（5．1±1．9）d，栓塞组分别为10ml（5～15m1）、（10．2±3．2）d，开腹组分别为200ml（80～300m1）、（11．3±3．3）d，阴式组分别为50ml（45-100m1）、（6．8±1．2）d，清宫组与栓塞组比较，差异均有统计学意义（P〈0．05），开腹组与阴式组比较，差异也均有统计学意义（P〈0．05）。结论清官术、子宫动脉栓塞术、开腹及阴式病灶清除术均可用于治疗CSP。若病灶植入肌层〉1／2或近浆膜层，需慎重选择介入手术；若病灶较大且周围血流信号丰富，慎重选择阴式手术。

Objective To investigate treatment of caesarean scar pregnancy （CSP） and associated problem. Methods From January 2011 to January 2013, 57 cases with CSP undergoing treatment in Affiliated Hospital of Hebei University were studied retrospectively. Among 57 patients, it was divided into 12 cases treated by curettage （curettage group） ;22 eases treated by uterine artery embolization（ embolization group） ;8 cases treated by laparotomy（ laparotomy group） and 15 cases treated by transvaginal debfidement （ transvaginal group）. Results （ 1 ） Successful rate of curettage group, embolization group, laparotomy group and transvaginal group were 12/12, 86% （19/22） ,7/8,13/15. （2） The intraoperative blood loss and the hospital stay were 20（17 -28） ml,（5.1 _＋ 1.9） clays in curettage group, 10（5 - 15） ml, （10.2 ± 3.2 ） days in embolization group, 200 （ 80 - 300 ） ml, （ 11.3 ± 3.3 ） days in laparotomy group, 50 （ 45 - 100） ml, （6. 8± 1.2 ） days in transvaginal group. There was statistically different between curettage group and embolization group （P 〈 0. 05 ） . There was statistically different between laparotomy group and transvaginal group （ P 〈 0. 05 ） . Conclusions Curettage, uterine artery embolization, abdominal and transvaginal scar debridement surgery can be used in treatment of the CSP. It should be carefully chosen with surgical intervention, if myometrium was implanted greater than 1/2, or near to serosa. It should be carefully chosen with vaginal surgery, if the blood flow signals was rich around the lesion.