87例剖宫产瘢痕妊娠临床分析  

Analysis of diagnosis and treatment of 87 patients with cesarean scar pregnancy

作　　者：刘斌 叶聪[2] 范明慧 胡宇博[2] LIU Bin;YE Cong;FAN Minghui;HU Yubo(Department of Obstetrics and Gynecology,Hunchun People's Hospital,Hunchun 133300,China;Department of Gynecology and Obstetrics,China-Japan Union Hospital of Jilin University,Changchun 130033,China)

机构地区：[1]珲春市人民医院妇产科,吉林珲春133300 [2]吉林大学中日联谊医院妇产科,长春130033

出　　处：《长春中医药大学学报》2020年第5期998-1001,共4页Journal of Changchun University of Chinese Medicine

基　　金：干细胞在子宫粘连中子宫内膜修复的机制研究(3R218I293430)。

摘　　要：目的探讨剖宫产瘢痕妊娠(CSP)的诊治方法。方法回顾性分析87例确诊为CSP患者的临床资料。超声引导下清宫术29例[直接超声引导下清宫术7例,米非司酮/甲氨蝶呤(MTX)/子宫动脉栓塞(UAE)单独或联合预处理清宫术22例]。米非司酮/MTX/UAE单独或联合预处理后宫腔镜下妊娠病灶清除术43例。经腹妊娠病灶清除术+子宫瘢痕修补术15例。结果7例直接超声引导下清宫术中3例2次手术。22例预处理后清宫术,2例出现胚胎残留。43例预处理后宫腔镜下妊娠病灶清除术,1例中转经腹手术。其余均治疗成功。经腹手术治疗均成功,无子宫切除。结论超声检查是诊断CSP的主要依据。子宫动脉化疗栓塞(UACE)后超声引导下清宫术(UACE+清宫术)疗效确切,UACE+宫腔镜具有独特优势。Objective To explore the diagnosis and treatment of cesarean scar pregnancy(CSP).Methods The clinical data of 87 patients with CSP diagnosed in our hospital were retrospectively analyzed.Ultrasound-guided uterine curettage was performed in 29 cases(7 cases with direct ultrasound-guided uterine curettage and 22 cases with mifepristone/MTX/UAE alone or combined used before treatment).A total of 43 cases received hysteroscopy and lesion excision after Mifepristone/MTX/UAE alone or combined used.A total of 15 cases underwent transabdominal lesion excision plus uterine scar repair.Results Within 7 cases underwent direct ultrasound-guided uterine curettage,3 cases underwent second operation.Within 22 cases were curettage after pretreatment,2 cases were residual.A total of 43 cases were treated by hysteroscopy and 1 case was transferred to transabdominal operation.The rest were treated successfully.Transabdominal surgery was successful without hysterectomy.Conclusion Ultrasonography is the main basis for the diagnosis of CSP.Ultrasound-guided uterine curettage after uterine artery chemoembolization(UACE with uterine curettage)has definite curative effect.UACE with hysteroscopy has unique advantages.

关 键 词：剖宫产瘢痕妊娠 甲氨蝶呤 双侧子宫动脉栓塞术 化疗栓塞 清宫术 宫腔镜 

分 类 号：R714[医药卫生—妇产科学]