CSP保留生育功能治疗的探讨——附46例病例分析

Treatment of retaining reproductive function in cesarean scar pregnancy:A clinical analysis of 46 cases

探讨剖宫产子宫瘢痕妊娠(CSP)的保留生育功能治疗方法的选择。对2000—2014年第二军医大学附属长海医院收治的46例CSP患者临床资料进行回顾性分析。孕早期45例,孕中期1例,13例(28.9%)早孕患者早期误诊而行负压吸引术或药流+清宫术。其余32例,根据CSP临床分型标准,Ⅰ型19例,Ⅱ型13例,全部病例均成功保留子宫,63.1%Ⅰ型CSP采用B超监护下清宫,21.0%Ⅰ型CSP采用子宫动脉栓塞(UAE)+B超监护下清宫;84.6%Ⅱ型CSP采用病灶切除+疤痕修补。1例中孕16+周外院引产发生产后大出血,UAE 30天后下肢血栓坏死转我院治疗,期间再次阴道大出血,手术探查证实为CSP,行病灶切除+瘢痕修补术。CSP治疗原则是早期诊断,及早处理,根据CSP临床分型、β-HCG等情况,选择个体化治疗是关键。临床上对CSP要保持高度警惕,尽早诊断,保留生育功能治疗是完全可行的。此外,UAE后仍存在一定风险,选择UAE要谨慎。

To investigate the treatment methods of retaining reproductive function in cesarean scar pregnancy. Clinical datus of 46 cases in our hospital during 2000―2014 were analyzed retrospectively. There were 45 cases of first- trimester pregnancy and 1 case of second- trimester pregnancy. 13 cases（28.9 %）of first- trimeste pregnancy were misdiagnosed and had received artificial abortion before hospitalization. According to cesarean scar pregnancy（CSP）classification,19 cases were type I,13 cases were type II,all cases were successful in retaining the uterus. 63.1 % of type I cases received uterine curettage under ultrasound monitoring,21 % of type I cases received uterine curettage after uterine artery embolization（UAE）. 84.6 % of type II cases received surgery in which lesion were resected and uterine scar were repaired. The csp patient of second-trimester pregnancy suffered from thrombosis of lower extremity and rebleeding 30 days after UAE, she received the surgery of resecting lesion. Conclusion：The key for the conservative treatment of CSP is early diagnosis and early treatment. Treatment should be individualized according to CSP clinic classification,β-HCG and so on.Furthermore,there are still some risk of UAE.We should be careful to select UAE for patients.