不同超声类型剖宫产瘢痕处妊娠的诊治体会

Diagnosis and Treatment of Cesarean Scar Pregnancy with Different Ultrasonographic Pattern

目的探讨甲氨蝶呤(methotrexate,MTX)妊娠囊内注射联合MTX肌内注射和子宫动脉栓塞(uterine artery embolization,UAE)+MTX灌注联合B超下刮宫对不同超声类型的剖宫产瘢痕处妊娠(cesarean scar pregnancy,CSP)的治疗效果。方法回顾性分析18例CSP患者,根据超声资料分为内生型和外生型,所有患者先予MTX妊娠囊内注射联合MTX肌内注射作为初始治疗,对治疗失败的患者追加UAE+MTX灌注联合B超下刮宫治疗,评价这两种方法对不同超声类型CSP的治疗效果。结果10例患者用MTX妊娠囊内注射联合MTX肌内注射治疗成功,失败的8例患者通过追加UAE+MTX灌注联合B超下刮宫治愈。对不同超声类型CSP,大部分内生型CSP(9/11,81.8%)可通过MTX妊娠囊内注射联合MTX肌内注射治疗成功,而绝大多数外生型CSP(6/7,85.7%)通过追加UAE+MTX灌注联合B超下刮宫治愈。所有患者均痊愈出院。结论 MTX妊娠囊内注射联合MTX肌内注射对内生型CSP有效,UAE+MTX灌注联合B超下刮宫相比于MTX妊娠囊内注射联合MTX肌内注射更适合外生型CSP。

Objective To compare the effectiveness of two treatments of cesarean scar pregnancy （CSP） with different ultrasonographic pattern：one treatment was local intragestational methotrexate （MTX） injection combined with intramuscular MTX injection,the other was curettage after uterine artery embolization （UAE） with local MTX infusion.Methods The results of 18 CSP cases were reviewed.All subjects were initially administrated with local intragestational MTX injection combined with intramuscular MTX injection.Curettage afte UAE with local MTX infusion was added to the patients who had failed local intragestational MTX injection combined with intramuscular MTX injection.The transvaginal ultrasonography data were retrospectively assessed,and two different ultrasonographic patterns were found：surface implantation and deep implantation of amniotic sac.The management and its effectiveness for patients with the two ultrasonographic patterns were studied retrospectively.Results Ten patients were successfully treated with local intragestational MTX injection combined with intramuscular MTX injection.The remaining 8 cases were successfully treated with additional curettage afte UAE with local MTX infusion.According to the ultrasonic classification,most surface implanted CSPs （9/11,81.8％） could be successfully treated with local intragestational MTX injection combined with intramuscular MTX injection.However,most deeply implanted CSPs （6/ 7,85.7％） had failed local intragestational MTX injection combined with intramuscular MTX injection but still could be successfully treated with additional curettage afte UAE with local MTX infusion.All patients recovered without severe side effects.Conclusion For most patients with surface implanted amniotic sac,local intragestational MTX injection combined with intramuscular MTX injection was effective.Curettage afte UAE with local MTX infusion would be the superior option in the cases with deep implantation of amniotic sac.