剖宫产瘢痕妊娠65例临床诊疗分析

Clinical analysis of the diagnosis and treatment of 65 cases of cesarean scar pregnancy

目的讨论剖宫产瘢痕妊娠的早期正确诊断方法和适当的治疗措施。方法回顾性分析2010年1月-2013年12月我院65例剖宫产瘢痕妊娠患者临床资料及临床诊疗经过。结果65例患者的平均年龄29．4岁，90％的患者仅有1次剖宫产手术史，发病至末次剖宫产术的间隔时间为1．5-7年，停经时间35-70d。最常见的临床表现为停经和阴道流血。65例病例经血B—HCG测定、经阴道超声检查确诊。28例接受甲氨蝶呤孕囊穿刺联合米非司酮治疗后进行刮宫术行保守治疗，25例接受腹腔镜手术治疗，12例接受经腹手术治疗，患者均痊愈，随诊血B—HCG值至正常。结论剖宫产术后子宫瘢痕妊娠临床表现缺乏特异性，容易误诊。对有剖宫产手术史的患者应结合妇科检查及辅助检查以早期诊断，强调根据患者情况予以个体化治疗，可获得较好疗效。

[ Objective ] To summarize the clinical characteristics of cesarean scar pregnancy （CSP） and to explore its early diagnosis and treatment. [Methods] Clinical data of 65 cases of CSP from January 2010 to December 2013 were reviewed and analyzed, including age of the patients, the interval from the last cesarean delivery to diagnosis, the clinical presentation, the location of the disease, the process of diagnosis and treatment, the outcome of the patients, were analyzed retrospectively using SPSS 11.0 software. [ Results ] The mean age of the group was 29.4 years. 90% of the women had only one prior cesarean delivery. The interval from the last cesarean delivery to diagnosis ranged from 1.5 years to 7 years. Gestational age at diagnosis ranged from 35 to 70 days. The most common presenting symptoms of CSP were amenorrhea and vaginal bleeding. The diagnosis was made through cesarean delivery history, blood β-HCG, trans-vaginal sonography. According to blood [5-HCG levels and scar thickness of lower uterine segment scar, given individual therapy, 28 cases treated with uterine curettage after gestational sac puncture with Methotrexate combined use of mifepristone, 25 treated with laparoscopic excision of CSP, 12 treated with trans-abdominal excision of CSP. All cases were cured and followed up blood β-HCG to normal. [ Conclusions ] CSP is rare and usually misdiagnosed as other diseases. Early diagnosis of this condition is possible through aggregate analysis of prior cesarean delivery, gynecologic examination and relative auxiliary examinations. Individual therapy is recommended and considerable effect can be seen after it.