包块型剖宫产瘢痕妊娠的临床特点分析  

Analysis of Clinical Characteristics of Mass Cesarean Scar Pregnancy

作　　者：张红霞 张坤[1] 杨艳[1] 姚颖[1] 王晓晔[1] 贺豪杰[1] 梁华茂[1] 郭红燕[1] 张璐芳[1] 韩劲松[1] Zhang Hongxia;Zhang Kun;Yang Yan(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科,北京100191

出　　处：《中国微创外科杂志》2022年第10期838-841,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨包块型剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的临床特点及治疗方法。方法回顾性分析2010年1月~2020年12月我院28例包块型CSP的临床特征及诊治情况。均有人流、药流或清宫史,术后异常阴道出血21例(其中失血性休克3例),血hCG下降不理想7例。入院距上次手术时间1~120 d,中位数21 d,其中<2周6例。包块直径14~66(35.3±14.7)mm;包块与膀胱间子宫肌层厚度1~5(1.7±1.0)mm。血β-hCG>1000 mIU/ml 18例(64.3%)。行宫腔镜手术10例,宫、腹腔镜联合手术9例,腹腔镜手术5例,开腹手术4例。结果行CSP残留组织清除27例,其中13例同时行剖宫产瘢痕修补,联合双侧子宫动脉栓塞或双侧子宫动脉上行支阻断6例,联合甲氨蝶呤治疗4例;腹腔镜全子宫双侧输卵管切除1例。手术均顺利完成,无并发症发生。其中5例术中或术后输悬浮红细胞400 ml。术后18~52 d(中位数26 d)血β-hCG降至正常范围。除全子宫切除术患者,余27例术后21~54 d月经复潮。结论剖宫产瘢痕处剩余肌层薄和包块大是包块型CSP的两个重要特点,可采用联合治疗以减少并发症,提高疗效。Objective To explore the clinical characteristics and treatment of mass cesarean scar pregnancy(CSP).Methods The clinical features,diagnosis and treatment of 28 cases of mass CSP in our hospital from January 2010 to December 2020 were analyzed retrospectively.All the patients had a history of abortion,drug abortion or curettage.Abnormal vaginal bleeding occurred in 21 cases(including 3 cases of hemorrhagic shock),and the decrease of blood hCG was not ideal in 7 cases.The interval between admission and the first operation was 1-120 d(median,21 d),6 of which were less than 14 d.The diameter of the mass was 14-66 mm(mean,35.3±14.7 mm).The thickness of myometrium between the mass and bladder was 1-5 mm(mean,1.7±1.0 mm).The bloodβ-hCG was higher than 1000 mIu/ml in 18 cases(64.3%).Ten patients underwent hysteroscopy,9 patients underwent hysteroscopy and laparoscopy,5 patients underwent laparoscopy,and 4 patients underwent open surgery.Results There were 27 cases undergoing CSP residual tissue removal,including 13 cases of combination with scar resection and uterus repair surgery,6 cases of combination with bilateral uterine artery embolization or bilateral uterine artery ascending branch occlusion,and 4 cases with methotrexate treatment.Another 1 patient underwent laparoscopic total hysterectomy with bilateral fallopian tubes.All the operations were successfully completed without complications.Among them,5 cases were infused with 400 ml of suspended red blood cells during or after operation.The bloodβ-hCG decreased to the normal range at 18-52 d after operation(median,26 d).Except for the total hysterectomy patient,the remaining 27 cases had menstrual rehydration at 21-54 d after operation.Conclusions Thin residual muscle layer and large mass at cesarean scar are two important characteristics of mass CSP.Combined treatment is necessary to reduce complications and improve the efficacy.

关 键 词：剖宫产瘢痕妊娠 腹腔镜手术 子宫动脉上行支阻断 子宫动脉栓塞 

分 类 号：R714.22[医药卫生—妇产科学] R719.8[医药卫生—临床医学]