51例剖宫产瘢痕妊娠的临床分析

目的:探讨剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的发病机制、早期诊断方法以及个体化的治疗方案。方法:回顾性分析2007年1月～2009年12月海淀区妇幼保健院收治的51例剖宫产瘢痕妊娠患者的临床资料,包括患者的发病年龄、孕周、剖宫产术至发病的间隔时间、首发症状、发病部位、诊疗过程、个体化的治疗方法及结局。结果:患者的平均年龄为31.1岁,48例有1次剖宫产手术史,3例有2次剖宫产手术史,此次妊娠距离前次剖宫产术后8个月～10年。32例主诉有停经史及阴道少量出血。17例无症状者彩超直接确诊瘢痕妊娠,1例误诊为早孕外院行刮宫术发生阴道大出血。1例误诊为稽留流产,共有49例治疗前确诊。通过剖宫产病史,妇科检查和血HCG、超声及MRI等辅助检查综合分析可明确诊断。治疗方法是根据彩超及血HCG值予以个体化治疗,包括米非司酮联合MTX全身药物保守治疗,或经米非司酮联合MTX全身药物保守治疗后,B超监测下行宫腔镜直视下刮宫术,术后予以球囊压迫宫腔止血。除1例转入外院,其余病例保守治疗均获成功,保留了生育功能。平均住院9天。结论:CSP的发病呈上升趋势,临床易误诊,早期诊断尤为重要。根据患者情况予以个体化治疗,可获得较好疗效。

Clinical analysis on 51 cases of cesarean scar pregnancy

Objective: To explore the pathogenesis, early diagnosis and individualized treatment of cesarean scar pregnancy. Methods: The clinical data of 51 patients with cesarean scar pregnancy in Maternal and Child Health Hospital of Haidian District from January 2007 to December 2009 were analyzed retrospectively,including age of onset,gestational weeks,interval time from the last cesarean delivery to diagnosis,the first symptom,location of the disease,the process of diagnosis and treatment,individualized treatment and outcomes. Results: The average age of patients was 31. 1 years,48 patients and 3 patients had history of cesarean delivery once and twice, respectively,the interval time from the last cesarean delivery to diagnosis ranged from eight months to ten years,32 patients complained history of menopause and vaginal bleeding; 17 patients without symptoms were diagnosed as asymptomatic cesarean scar pregnancy definitely by ultrasound,one patient was misdiagnosed as early pregnancy outside the hospital and severe vaginal bleeding occurred during uterine curettage; one patient was misdiagnosed as missed abortion,49 patients were diagnosed definitely before treatment by history of cesarean delivery, gynecological examination,serum human chorionic gonadotropin ( HCG) ,ultrasound and magnetic resonance imaging ( MRI) . Individualized treatment was conducted according to color Doppler ultrasound and serum HCG level,including drug conservative therapy of mifepristone combined with methotrexate,or uterine curettage under hysteroscope after drug conservative therapy of mifepristone combined with methotrexate,then postoperative intrauterine pressure was applied to stop bleeding by balloon. All the patients were cured with drug conservative thera- py and their reproductive function was retained except a case transferred to other hospital,the average hospitalization time was 9 days. Conclusion: The incidence of cesarean scar pregnancy increases,which is easy to be misdiagnosed,the early diagnosis is important, the therapeutic effect of individualized treatment is good.