内生型子宫瘢痕妊娠临床诊治分析

Clinical diagnosis and treatment of endogenous type of uterine cesarean scar pregnancy

目的探讨内生型子宫瘢痕妊娠(CSP)临床特点、诊断和治疗方式。方法回顾性分析中国人民解放军北京军区总医院2008年1月至2014年6月收治确诊为内生型CSP患者41例,治疗方式分为三组:药物(甲氨喋呤MTX+米非司酮)+宫腔镜清宫术组13例;介入组1:子宫动脉MTX灌注栓塞+宫腔镜清宫术组18例;介入组2:子宫动脉MTX灌注栓塞+腹腔镜监测下清宫术组10例。比较各组首次治疗的治愈率、出血量、住院时间、血hCG转阴时间、住院费用以及不良反应的发生情况。结果 21例(51.2%)有停经后阴道不规则出血;18例(43.9%)患者超声提示胚胎停育,经阴道超声诊断准确率为92.7%;介入组首次治疗治愈率明显高于药物组(53.8%)(P<0.05);并且介入组出血量明显少于药物组(P<0.05)以及住院时间明显短于药物组(P<0.05);介入组1与介入组2疗效比较差异无统计学意义(P>0.05),两组出血量及住院时间比较差异无统计学意义(P>0.05),但住院费用介入组1明显少于介入组2(P<0.05);血hCG转阴时间各组比较差异无统计学意义(P>0.05);各组均无严重的不良反应发生。结论子宫动脉MTX灌注栓塞后宫腔镜+清宫术是治疗内生型CSP的一种有效、安全、快速,能够防止严重出血的治疗方式。

Objective To investigate the clinical features,diagnosis criteria and treatment of endogenous uterine cesarean scar pregnancy（CSP）.Methods 41 cases of endogenous CSP admitted to gynecological department of Beijing General Army Hospital from January 2008 to June 2014 was analyzed retrospectively.They were divided into different groups according to the treatments.Drug group：13patients received Methotrexate（MTX）and Mifepristone treatment combined with hysteroscopy and curettage（drug group）;Intervention group 1∶18patients underwent uterine artery embolization（UAE）in combination with local injection of MTX followed by hysteroscopy and curettage;Intervention group 2∶10patients underwent UAE in combination with local injection of MTX followed by curettage under laparoscopic monitor.The cure rate,blood loss,hospitalization stay,time for HCG recovery,hospitalization expenses and adverse effect were compared among those groups.Results 21 cases of them（51.2%）showed irregular vaginal bleeding after menopause.18 patients（43.9%）with embryo growth stop showed by ultrasound.The diagnosis accurate rate of transvaginal ultrasound was 92.7%;curerate of first treatment in intervention group（96.4%）was higher than drug group（53.8%）（P〈0.05）;The amount of bleeding was significantly less in intervention group than that in drug group（P〈0.05）;The hospitalization stay of intervention group was shorter than that in drug group（P〈0.05）;Meanwhile no significant differences of first treatment of cure rate,blood loss and hospitalization stay were observed between the two intervention groups（P〈0.05）,But hospitalization expenses of group 1was significantly less than that of group2（P〈0.05）;and there was no significant differences of time for blood hCG recovery between those groups（P〈0.05）;No serious adverse reactions occurred in those groups.Conclusion UAE in combination with local injection of MTX followed by hysteroscopy and curettage is an effective therapy of endogenous CSP,moreover it had been proved to be an effective,safe,fast treatment which can prevent severe bleeding.