剖宫产瘢痕妊娠38例临床分析

Clinical analysis of 38 cesarean scar pregnancy cases

目的探讨子宫下段剖宫产瘢痕妊娠治疗策略的选择,为临床合理诊治提供方法及依据。方法回顾性分析38例剖宫产瘢痕妊娠患者的临床资料,分析其诊断及其治疗过程。结果 38例患者均有停经,阴道流血者有32例(84.2%),6例表现为阴道流血伴下腹部轻微疼痛(15.8%),全部伴有血人绒毛膜促性腺激素(HCG)升高。38例均由盆腔彩超检测诊断,32例行药物治疗+清宫术,其中1例行子宫切除术;6例行腹腔镜下子宫切口瘢痕妊娠清除术,过程顺利。结论子宫下段剖宫产瘢痕妊娠的治疗方法多样化,其中甲氨蝶呤(MTX)孕囊内注射后等待HCG下降至1000 U/L后清宫及腹腔镜下病灶切除手术方法出血较少且疗效显著,临床要提高剖宫产瘢痕妊娠的诊断水平,早诊断,早治疗,避免严重并发症的发生,尽可能保留患者生育功能,保证患者生命健康。

Objective To investigate choice of treatment strategies for uterine lower segmental cesarean scar pregnancy, and to provide method and reference for rationally clinical diagnosis and treatment. Methods Clinical data of 38 patients with cesarean scar pregnancy were retrospectively analyzed, along with their diagnosis and treatment process. Results Menolipsis occurred in all the 38 cases. There were 32 cases with vaginal bleeding（84.2%）, 6 cases with vaginal bleeding and complicated mild lower abdominal pain（15.8%）, and all of the cases with increased human chorionic gonadotropin（HCG）. Pelvic color Doppler ultrasound was used in detection and diagnosis for all the 38 cases. There were 32 cases receiving drug therapy ＋ uterine curettage, while 1 case among them received hysterectomy. The other 6 cases received laparoscopic removal of cesarean scar pregnancy with successful process. Conclusion Among multiple treatment methods for uterine lower segmental cesarean scar pregnancy, uterine curettage after decreased HCG to 1000 U/L by gestational sac injection of methotrexate（MTX） and laparoscopic lesion resection can provide few bleeding and precise effect. Improvement of clinical diagnosis for cesarean scar pregnancy, early diagnosis and treatment are necessary for avoiding occurrence of severe adverse reactions, and guaranteeing fertility function and health in patients.