剖宫产瘢痕妊娠70例临床分析

Clinical analysis of 70 cases of cesarean scar pregnancy

目的探讨剖宫产瘢痕妊娠（cesarean scar pregnancy,CSP）临床诊治方法及结局。方法收集2012年1月至2014年12月厦门大学附属第一医院70例CSP患者的临床资料并作回顾性分析。结果70例诊断为CSP的患者孕周为5~16周,孕周≤12周的65例患者选择终止妊娠,其中24例行子宫动脉栓塞＋刮宫术,6例行经阴道病灶切除术,3例行宫腔镜手术,4例行腹腔镜手术,20例药物治疗配合刮宫术,8例单纯药物治疗,均达到治愈目的,无1例子宫切除。5例患者诊断时孕周为14~16周,选择继续妊娠,其中1例23周死胎并胎盘植入出血,切除子宫;4例在27~32周之间剖宫产,3例新生儿存活。结论 CSP是剖宫产术后严重的远期并发症,应根据具体情况选择个体化治疗,虽然继续妊娠可能分娩活婴儿,但孕妇面临胎盘植入大出血导致子宫切除的风险也增加。

Objective To investigate the clinical diagnosis,treatment and outcomes of cesarean scar pregnancy. Methods The clinical data of 70 cases of cesarean scar pregnancy women treated in the first affiliated hospital of Xiamen University from January 2012 to December 2014 were analyzed retrospectively. Results 70 cases of cesarean scar pregnancy patients were diagnosed between 5 ~ 16 gestational weeks. 65 patients whose gestational weeks less than or equal to 12 weeks chose pregnancy termination,in which 24 cases were treated by uterine artery embolization（ UAE） and curettage,6 cases received transvaginal lesion resection,3 cases received hysteroscopic surgery,4 cases received laparoscopic surgery,20 cases were treated by drug and curettage,8 cases were treated by drug only. All these patients were cured,none received hysterectomy. The other 5 patients diagnosed between 14 ~ 16 gestational weeks continued the pregnancies. One case had hysterectomy due to placenta accrete bleeding and stillbirth in 23 gestational weeks. Four cases were treated by cesarean delivery between 27 to 32 weeks,in which three newborns survived. Conclusion Cesarean scar pregnancy is one kind of serious complications of cesarean delivery. Every case should receive individualized treatment. Though continuing the cesarean scar pregnancy is possible to have a live newborn,but the risk of hysterectomy due to placenta accrete bleeding increases.