剖宫产术后瘢痕部位早期妊娠临床分析

Clinical analysis of early scar pregnancy after cesarean section

目的探讨剖宫产术后子宫瘢痕妊娠(CSP)的临床特点和治疗方法。方法 112例剖宫产术后子宫瘢痕妊娠的患者分为米非司酮组(16例)、氨甲蝶呤(MTX)组(20例)、米非司酮+MTX组(35例)、子宫动脉栓塞术(UAE)+MTX组(41例)。观察四组的临床疗效。结果 UAE+MTX组术后血β-人绒毛膜促性腺激素(β-hCG)下降水平、阴道出血时间、月经恢复时间、住院时间均明显低于米非司酮组、MTX组、米非司酮+MTX组,差异均有统计学意义(P<0.01);但住院费用、治疗期间风险明显高于其他三组。治愈率:MTX组为90%,2例患者血β-hCG下降不理想,行B超监测下刮宫术,1周后复查血β-hCG下降,28 d降至正常;米非司酮组、米非司酮+MTX组、UAE+MTX组治愈率均为100%。结论剖宫产术后子宫瘢痕妊娠比较少见,临床表现不典型,易发生误诊误治。超声检查是有效的诊断方法。治疗方案应根据患者病情进行个体化综合治疗。

Objective To study the clinical characteristics and treatment of cesarean scar pregnancy. Methods One hun- dred and twelve cases with cesarean scar pregnancy were divided into mifepristone group（ 16 cases）, methotroxate group（20 ca- ses）, mifepristone ＋ methotroxate group （35 cases）, uterine artery embolization ＋ methotroxate group （41 cases）. The clinical curative effect of four groups was observed. Results The decreased level of serum β- hCG after surgery, vaginal bleeding time, menstrual recovery time, hospitalization time in UAE ＋ MTX group was lower than that in mifepristone group, MTX group and mifepristone ＋ MTX group, the differences were statistically significant （P 〈 0.01 ） ; But the hospitalization expenses and treat- ment risks were higher than that of other three groups. The cure rate of MTX Group was 90% , 2 patients＇serum β- HCG levels had no obviously decreased, they were treated by detection of curettage by B - ultrasound guiding, the serum β- hCG level was decreased after 1 week, and the serum β- hCG level was dropped to normal after 28 days. The cure rate of mifepristone group, mifepristone ＋ MTX group and UAE ＋ MTX group was 100%. Conclusion Cesarean scar pregnancy is relatively rare, the clini- cal manifestation is not typical, prone to misdiagnosis. Ultrasound is an effective diagnostic method, and patients should be give the individualized treatment.