剖宫产瘢痕妊娠142例临床分析

Clinical Analysis of Cesarean Scar Pregnancy: Report of 142 Cases

目的：探讨剖宫产瘢痕妊娠（ cesarean scar pregnancy ，CSP）的临床特点、诊断及治疗方法。方法回顾性分析2010年1月～2015年7月142例CSP资料。 B超引导下孕囊内注射甲氨蝶呤（ MTX）9例，MTX＋米非司酮后清宫15例，子宫动脉栓塞（ UAE）＋清宫62例，经阴道子宫下段切开取胚＋子宫缺陷修补术48例，腹腔镜下子宫下段病灶切除术5例，经腹子宫下段病灶切除术3例。结果孕囊内注射MTX治疗1例和UAE＋清宫2例因宫腔残留行清宫术，其余均治疗成功。清宫术77例中子宫穿孔3例（3．9%）。结论 CSP缺乏特异性临床表现，超声是诊断的主要依据。根据CSP病情不同采用6种方法，均可达到治疗目的。CSP的具体处理方式，与医生的手术能力有关，腹腔镜或经腹手术适用于门诊手术已穿孔大出血的病例，具有丰富阴式手术经验的医生可行经阴道子宫下段切开取胚术。

Objective To discuss clinical features, diagnosis and treatment of cesarean scar pregnancy （CSP）. Methods A retrospective analysis was conducted on clinical data of 142 CSP cases from January 2010 to July 2015.There were 9 cases of B ultrasound-guided injection of methotrexate （ MTX ） to the gestational sac , 15 cases of curettage after administration of MTX and mifepristone , 62 cases of uterine artery embolization （ UAE） and complete curettage of uterine cavity , 48 cases of transvaginal removal of ectopic pregnancy tissue with repair of the uterine defect , 5 cases of laparoscopic lower uterine segment lumpectomy , and 3 cases of transabdominal uterine segment lumpectomy . Results Except 1 case of gestational sac MTX injection and 2 cases of UAE plus curettage were found intrauterine residue leading to second curettage , the remaining cases were successfully treated .Uterine perforation was seen in 3 out of 77 cases of curettage （3.9%）. Conclusions CSP lacks of specific clinical manifestations , and ultrasound examination is the main basis for the diagnosis .According to the condition of CSP , 6 methods can be used to reach the goal of treatment.The selection of treatment methods is related to doctor ’s ability.Laparoscopy and abdominal surgery apply to perforated and massive hemorrhage in outpatient surgery .With rich experience of vaginal surgery , doctors may consider transvaginal removal of ectopic pregnancy tissue with repair of the uterine defect .