剖宫产术后子宫切口瘢痕妊娠的诊断及临床治疗分析  

Clinical analysis and diagnosis of cesarean scar pregnacy

作　　者：孙广范[1] 林霞[1] 尚雪[1] 栾峰[1] 

机构地区：[1]南方医科大学附属中山博爱医院妇科,广东广州528425

出　　处：《中国计划生育和妇产科》2013年第3期62-65,共4页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的分析讨论剖宫产术后子宫切口瘢痕妊娠(cesarean scar pregnancy,CSP)的诊断及治疗方法。方法回顾性分析中山博爱医院2007年1月至2012年1月期间收治的42例CSP患者的临床资料。结果 18例行子宫动脉栓塞加灌注化疗及清宫术,在栓塞术后3～7d行超声监视下清宫术;11例在B超引导下行清宫术治疗;10例予甲氨蝶呤(methotrexate,MTX)保守治疗。7例行CSP病灶清除术,其中2例为清宫术中子宫大出血行腹式CSP病灶清除术,2例为药物保守治疗后仍大出血,行腹腔镜下CSP病灶清除术,3例行阴式CSP病灶清除术,术后复查血β-人绒毛膜促性腺激素(human chorionic gonadotrophin,HCG)下降明显,术中术后均未见并发症发生。术后血β-HCG降至正常的时间为14～56d,平均20.5d;月经恢复在治疗后30～68d,平均42.5d;B超检查包块消失的时间为3～6个月。结论早期及时诊断CSP,采取个体化治疗,以保留患者的生育功能。Objective To explore the diagnosis and individualized treatment of cesarean scar pregnancy （CSP）. Methods The clinical data of 42 patients with CSP in Boai Hospital of Zhongshan from January 2007 to January 2009 were analyzed retrospectively. Results Among 42 cases, 18 patients with uterine artery embolization （UAE） with intra-arterial injection of gethotrexate（MTX） received the Ultrasound guided curettage after 3-7 days of the UAE. Eleven patients only received the Ultrasound guided curettage. Ten cases were successfully cured by conservation treatment of MTX. Seven patients were treated by cesarean scar pregnancy focal debridement surgery, two of them were treated by open surgery because of massive hemorrhage after failure of uterine curettage, two of them were treated by laparoscopic surgery because of failure of conservative medical treatment, 3 patients were treated by transvaginal surgery, all the 7 surgical patients were less damage and rapid postoperative recovery, the recovery time of blood β - human chorionic gonadotrophin （ β - HCG） levels was 14 - 56 days （ mean = 20. 5 d ） , recovery ofmenstruation after operation was 30 -68 days（ mean = 42. 5 d）, and the mass had been disappeared by B -ultrasound examination in three to six months. Conclusion The patients＂ reproductive function could be preserved with early diagnosis CSP and individualized treatment.

关 键 词：剖宫产切口瘢痕妊娠 子宫动脉栓塞术 清宫术 

分 类 号：R714.2[医药卫生—妇产科学]