剖宫产术后子宫瘢痕妊娠的诊治决策

The Influencing Factors and Treatment of Cesarean Scar Pregnancy

目的：探讨剖宫产术后子宫瘢痕妊娠（cesaren scar pregnancy，CSP）的诊治决策。方法：选择解放军总医院2007年1月-2012年8月因CSP住院治疗的患者51例，统计患者剖宫产指征、次数、术后恢复情况及发病时间。针对患者具体病情采用清官、子宫动脉栓塞、宫腹腔镜诊治、经阴道病灶切除及子宫切除等方式治疗。结果：所有病例均经超声诊断。患病距上次剖宫产时间5-147个月，平均（60．5±9．5）个月。妊娠2-6次，除10例（19．61％）为临产后剖宫产外，41例（80．39％）为未临产选择性子宫下段横切口剖宫产。48例患者经保守治疗成功：其中8例超声监测下单纯清官、19例子宫动脉栓塞后清宫、8例在腹腔镜或宫、腹腔镜联合监测下清官、11例行宫颈局部注射或深部肌内注射甲氨蝶呤、2例经阴道行子宫前壁修补术，另3例切除子宫（其中1例死亡）。结论：CSP属高危妊娠，早期诊断、谨慎处理至关重要。超声是诊断CSP的有效方法。

Objective： To investigate the influencing factors of cesarean scar pregnancy （CSP） and the suitable measures of diagnosis and treatment. Methods：From January 2007 to August 2012,51 cases were diagnosed as CSP in our hospital. The patients＇ information were analyzed such as the indications of cesarean, postoperative recovery and the CSP time. According to patients＇ condition curettage, uterine artery embolism, laparoseopie and/or hysteroscopic treatment, exsecting the focus per vagina, hysterectomy were selected. Results ： All the cases were diagnosed by transvaginal ultrasound. The time of occurrence CSP were 5-147 months （average 60.5±9.5 ）. Gravidity 2-6. Excepting 10 （19.61%） cases performed cesarean after uterine contraction, 41 （80.39%）cases were selectively cesarean without any uterine contraction. 48 （94.12%） cases were cured successfully by conservative treatment. Of those 8 cases with ultrasonic monitoring, 19 cases after uterine artery embolism, 8 cases monitored by laparoscope or/and hysteroscope, 11 intramuscular or cervical injection with methotrexate, 2 anterior uterine wall neoplasty per vagina. 3 cases were performed hysterectomy with heavy bleeding, one case died of hemorrhagic shock. Conclusions：CSP are high-risk pregnancy, it＇s very important with early diagnose and suitable treatment. Transvaginal ultrasound is the preferred diagnostic method of CSP.