剖宫产术后子宫瘢痕妊娠临床分析

Clinical analysis of cesarean scar pregnancy

目的：探讨剖宫产术后子宫瘢痕妊娠（CSP）的诊断和治疗。方法回顾性分析2009年3月~2013年10月辽宁省盘锦市第二人民医院和盘锦市中心医院（以下合并简称“我院”）收治的18例CSP患者，其中16例CSP患者予甲氨蝶呤（MTX）50 mg/m2一次肌内注射联合口服米非司酮50 mg（米非司酮首次加倍口服），2次/d，连用3 d，对血人体绒膜促性腺激素（HCG）值下降满意者行超声指导下清宫术，2例患者因外院人流过程中阴道大量出血转入我院，无法行药物保守治疗，及时行双侧子宫动脉栓塞。结果药物治疗加清宫9例，药物治疗加清宫术并给予宫腔Foley导管压迫治疗4例，双侧子宫动脉栓塞介入治疗2例，手术治疗3例。18例中治疗成功15例，失败3例。结论剖宫产术后子宫瘢痕妊娠患者，治疗关键是早期诊断，早期处理，一经明确诊断应立即终止妊娠。术前药物（MTX＋米非司酮）预处理，术中联合B超监测行清宫术是目前治疗剖宫产术后子宫瘢痕妊娠的有效措施，能够保留患者生育功能，是一种可供选择的有效治疗方法。

Objective To discuss the diagnosis and treatment of cesarean scar pregnancy （CSP）. Methods A retrospec-tive analysis of 18 cases of CSP admitted to the Second People＇s Hospital in Panjin and Panjin Center Hospital （＂our hospital＂ for short） from March 2009 to October 2013. Among the 18 cases, 16 patients were treated with intramuscular amethopterin （MTX） 50 mg/m2 combined with oral mifeprostone 50 mg （doubling the dose for the first time） bid for 3 days. For patients with satisfactory decrease in serum HCG, they were treated with curettage under the guidance of B-ultrasound. Two patients were transferred to our hospital due to heavy vaginal bleeding, who could not be treated with conservative medication treatment, and were treated with bilateral uterine artery embolism. Results Of the 18 cases, 9 cases were treated with medication combined with curettage, 4 cases were treated with medication and curettage and were given intrauterine Foley pipe compression, 2 cases were treated with bilateral uterine artery embolism,3 cases were given surgery for treatment. This study got successful results in 15 cases and failed in 3 cases. Conclusion For the patient of cesarean scar pregnancy （CSP）, the key lies in early diagnosis, early treatment and instant cease of preg-nancy. The pre-operative treatment of medication of MTX and mifeprostone and intra-operative curettage under the guidance of B-ultrasound are effective measures to treat cesarean scar pregnancy, which can reserve patients’reproduc-tive function.