剖宫产术后子宫瘢痕妊娠9例的临床诊治  

Clinical diagnosis and treatment of cesarean scar pregnancy in 9 caces

作　　者：罗永红[1] 金兰[1] 

机构地区：[1]皖南医学院附属弋矶山医院妇产科,安徽芜湖241001

出　　处：《皖南医学院学报》2014年第2期125-128,共4页Journal of Wannan Medical College

摘　　要：【摘要】目的：探讨剖宫产术后子宫瘢痕部位妊娠（CSP）的诊断及治疗方法。方法：回顾性分析皖南医学院附属弋矶山医院妇产科2012年4月-2013年8月收治的9例CSP患者的临床资料。结果：所有患者均有停经史，7例有不规则阴道流血（77．8％），其中2例有下腹痛；2例（22．2％）无典型症状。血中人绒毛膜促性腺激素β亚单位（β-hCG）水平介于56．17～125809．51mU／ml之间，其中血β-hCG≥10000mU／ml者7例；8例经彩超明确诊断，4例因需确定治疗方案或B超难以确诊行盆腔MRI检查。9例患者中2例采用MTX肌注保守治疗，3例采用子宫动脉栓塞（UAE）＋清宫术，4例患者行经阴道瘢痕妊娠切除＋子宫瘢痕缺陷修补术。9例患者治疗后血β-hCG均明显下降，无1例切除子宫。结论：CSP症状常不典型，辅助检查首选经阴道彩超。MTX全身用药、动脉介入栓塞治疗、子宫病灶切除术是CSP的主要治疗方法，应用恰当均可取得良好效果；血β-hCG是随访监测、判断疗效的重要指标。Objective ： To determine the strategy for diagnosis and treatment of cesarean sear pregnancy （CSP）. Methods ： The clinical data were retrospec- tively examined in 9 cases of CSP undergone treatment in our department between Apr. 2012 and Aug. 2013. Results：The total 9 patients had history of suppressed menstruation, among whom 7 （ 77. 8% ） presented with irregular vaginal bleeding, 2 complained of abdominal discomfort, and another 2（22.2% ） had no typical symptoms. By admission, the total cases demonstrated elevated serum free beta-hunmn chorionic gonadotropin （ β-hCG ）level （ 56.17 - 125 809.51 mU/ml）, in whom the β-hCG〉- 10 000 mU/ml was seen in 7. Eight patients were diagnosed with CSP by color Doppler uhrasonog- raphy. Magnetic resonance imaging （MRI） was performed in 4 cases due to hard planning of the therapy and failure of B-type ultrasonography confiiyna- tion. Of the 9 patients,2 were treated by intramuscular injection of methotrexate （MTX） ,3 by uterine artery embolization plus curettage, and 4 by transvagi- nal removal of ectopic pregnancy tissue plus repair of the uterine defect for CSP. After treatment, serum β-hCG levels were significantly decreased in the 9 cases, and no single case required hysterectomy. Conclusion ： Women with CSP may be asymptomatic, and transvaginal color Doppler ultrasound shall be the principal tool for early diagnosis of CSP. Intramuscular administration of MTX, uterine artery embolization plus curettage and lesion excision for the ute- rus are current options for individualized treatment, and may lead to better outcomes. In addition, monitoring of β-hCG level will be key indicator in follow- up and evaluation of the therapeutic efficacy.

关 键 词：剖宫产切口瘢痕妊娠(CSP) 诊断 治疗方案 

分 类 号：R714.2[医药卫生—妇产科学]