剖宫产瘢痕妊娠19例诊治体会  

Diagnosis and Treatment of 19 Cases of Cesarean Scar Pregnancy

作　　者：汪邦兰[1,2] 陈红波[1,2] 

机构地区：[1]安徽医科大学妇幼保健临床学院 [2]安徽省妇幼保健院妇产科,合肥市230001

出　　处：《中华全科医学》2013年第8期1194-1196,共3页Chinese Journal of General Practice

摘　　要：目的探讨剖宫产瘢痕妊娠(CSP)的早期诊断及治疗方法。方法本组19例CSP患者12例因少量阴道出血、7例因要求终止妊娠而就诊。19例均行血β-HCG测定证实妊娠,经阴道彩色多普勒显像(TVCDI)检查确定CSP诊断。本组均予以米非司酮75 mg口服,12 h一次,共5 d。同时配伍甲氨蝶呤(MTX),应用方法一是单剂量MTX(50 mg/m2)肌内注射,二是超声引导下局部妊娠囊内注入MTX。用药3 d及1周后β-HCG值下降大于50%后行超声引导下清宫术。结果米非司酮+肌注甲氨蝶呤治疗组15例,1周后行清宫术13例;2例因并发阴道大量流血行子宫动脉栓塞(UAE),1例止血成功后行清宫术,1例止血失败后急诊行子宫瘢痕处妊娠物切除。米非司酮+甲氨蝶呤局部妊娠囊注射4例,1周后行清宫术。所有病例均痊愈出院,随访3个月均无并发症发生。结论 TVCDI在CSP早期诊断方面有重要价值。应用甲氨蝶呤+米非司酮药物后行清宫术是治疗CSP的有效方法。治疗中发生阴道大出血时,可优先选择子宫动脉栓塞止血,必要时手术治疗。Objective To explore the diagnosis,treatment and prognosis of cesarean scar pregnancy（CSP）.Methods The pregnancy of 19 cases were confirmed by Human chorionic gonadotropin（HCG） level,and CSP by transvaginal color Doppler imaging（TVCDI）.All patients received oral mifepristone 75 mg,bid for 5 days.50 mg / m2 methotrexate（MTX） was used by intramuscular injection or gestational sac injection guided by B ultrasound.When β-HCG decreased more than 50% after the administration（3 days to 7 days）,complete curettage surgery was performed ender B ultrasound.Results There were 15 cases received mifepristone and MTX intramuscular injection,13 of them underwent complete curettage surgery one week late,2 of them underwent uterine arterial embolization（UAE） because of vaginal bleeding,in which 1 case underwent complete curettage surgery after hemostasis,another case underwent Removal of scar pregnancy because of the failure of hemostasis.There were 4 cases received mifepristone and MTX gestational sac injection,all of them underwent complete curettage surgery one week late.All patients were cured and discharged from hospital.No complication was found during the 3 months of follow up.Conclusion TVCDI had a high value for the diagnosis and differential diagnosis of CSP.Curettage after mifepristone combined with methotrexate（MTX） is an effective method for the scar pregnancy.UAE was an effective means while haemorrhage ocurred.

关 键 词：剖宫产 子宫瘢痕妊娠 经阴道彩色多普勒显像 米非司酮 甲氨蝶呤 

分 类 号：R714.2[医药卫生—妇产科学]