剖宫产瘢痕部位妊娠的临床特征及治疗策略

Clinical characteristics and treatment strategy of cesarean scar pregnancy

目的探讨剖宫产瘢痕部位妊娠(CSP)的临床特征及不同治疗方法和临床结局。方法选取2013年9月至2016年10月收治的96例剖宫产瘢痕部位妊娠的患者临床资料为研究对象。对患者临床特征、术中情况、术后血人绒毛膜促性腺激素(β-h CG)、术后阴道流血时间、住院时间、住院费用以及治疗方式等情况进行分析。结果分型是决定CSP行治疗方案的主要因素,其次是肿块大小和血β-h CG水平;行病灶切除可能对于妊娠物的清除更彻底。行子宫动脉栓塞术(UAE)组术中出血量与未行UAE组比较明显减少。子宫病灶切除者住院时间要短,清宫患者阴道流血时间相对比较长。结论阴道彩超和MRI对CSP的诊断有重要价值,在CSP治疗中应该根据分型、包块大小和β-h CG水平综合考虑选择最佳个体化治疗方案,早期诊断、早期治疗是降低CSP并发症的主要因素。

Objective To explore the characteristics of cesarean scars pregnancy(CSP)and discuss different therapeutic methods and clinical outcomes.Methods Clinical data of96cases of CSP were collected from September2013to October2016and patients′clinical features,intra?operative findings,β?HCG,vaginal bleeding duration,hospital stay and cost and effects of different treatments were recorded and analyzed.Results The types of CSP were the determinant of lesion resection,followed by the tumor size and bloodβ?HCG levels.The cases of uterine lesion resection and general uterine curettage with UAE had less blood loss than those without UAE.The cases of uterine lesion resection had short hospital stay and those with general uterine curettage had longer vaginal bleeding duration.Conclusion TVCD and MRI have important values in the diagnosis of CSP.During the treatment of CSP,personalized treatment planning,early diagnosis and treatment exert influence on reducing complications.