剖宫产瘢痕妊娠误诊误治的原因及预后  

Causes of Misdiagnosis and Mistreatment of Cesarean Scar Pregnancy and Its Prognosis

作　　者：欧阳振波[1] 吴嘉雯 王卫 万子贤 魏世远 钟碧婷 李群 张敏 李凤[1] OUYANG Zhen-bo;WU Jia-wen;WANG Wei;WAN Zi-xian;WEI Shi-yuan;ZHONG Bi-ting;LI Qun;ZHANG Min;LI Feng(Department of Gynecology,the Second General Hospital of Guangdong Province,Guangzhou 510317,China;Department of Obstetrics and Gynecology,People's Hospital of Zhongshan City,Zhongshan,Guangdong 528403,China)

机构地区：[1]广东省第二人民医院妇科,广州510317 [2]中山市人民医院妇产科,广东中山528403

出　　处：《临床误诊误治》2021年第10期5-8,共4页Clinical Misdiagnosis & Mistherapy

基　　金：广东省医学科学技术研究基金(A2020244);中山市医学科研项目(2018A020175)。

摘　　要：目的探讨剖宫产瘢痕妊娠(CSP)误诊误治的原因及预后。方法回顾性分析2017年1月—2020年12月初诊时出现误诊及误治的35例CSP的临床资料,分析其误诊误治的原因及预后。结果本组误诊误治率为17.7%。有28例超声诊断为宫内妊娠及可疑CSP,是误治的主要原因,余7例为诊断CSP后误治。所有患者经阴道彩超检查确诊,误治时导致大出血者主要采用子宫动脉栓塞治疗(13/35),其余主要采用腹腔镜下瘢痕妊娠病灶切除术(12/35)及甲氨蝶呤治疗(8/35)。除1例切除子宫外,其余患者预后良好。结论检查方法的选择不当及经验不足是CSP误诊的主要原因。误诊及盲目的试验性治疗是CSP误治的重要原因。CSP补救治疗的难度及风险较初始治疗更大,应根据患者的具体情况进行个体化的综合考虑。Objective To explore causes of misdiagnosis and mistreatment of cesarean scar pregnancy(CSP)and its prognosis.Methods Clinical data of 35 patients with CSP who had been misdiagnosed and mistreated between January 2017 and December 2020 was retrospectively analyzed,and the causes of misdiagnosis and mistreatment and their prognoses were analyzed.Results In this group,the misdiagnosis and mistreatment rate was 17.7%,and 28 patients were diagnosed as having intrauterine pregnancy and suspected CSP by ultrasound,which were the main reasons for mistreatment,and the other 7 patients were mistreated after CSP diagnosis.All the patients were confirmed by transvaginal color Doppler ultrasound.During mistreatment,patients with hemorrhage were mainly treated with uterine artery embolization(13/35),and the remaining patients were mainly treated with laparoscopic hysterotomy(12/35)and Methotrexate(8/35).Except for one patient underwent hysterectomy,prognoses of the other patients were favorable.Conclusion Improper selection of examination methods and insufficient experiences are the main reasons for misdiagnosis of CSP.Misdiagnosis and blind experimental treatment are important reasons for the mistreatment of CSP.CSP salvage treatment is more difficult and risky than those by initial treatment,and individualized comprehensive consideration should be carried out according to the specific conditions of each patient.

关 键 词：剖宫产瘢痕妊娠 误诊 误治 子宫动脉栓塞 预后 

分 类 号：R714.22[医药卫生—妇产科学]