剖宫产瘢痕妊娠27例诊治分析

目的探讨剖宫产瘢痕妊娠(CSP)的合理诊治方法。 方法回顾性分析2005年1月至2011年9月中山大学孙逸仙纪念医院收治的27例CSP患者的临床资料，对其病史、临床表现、辅助检查、诊断、处理及结局等进行总结分析。外院转入组与我院首次接诊组患者的孕次、产次、距末次剖宫产时间、停经天数、入院时HCG值的比较应用t检验，两组的开腹手术比例、包块型比例的比较应用卡方检验。 结果27例患者中外院转入者13例，均在外院行药流或清宫术后，因反复阴道流血或突发性大量阴道流血转入我院；首次就诊我院者14例。我院首次接诊组与外院转入组比较，停经天数(57.1±17.8)d与(83.5±28.4)d，t＝2.910；开腹手术比例(1例与7例)，χ²＝7.050；超声表现为包块型的比例(1例与13例)，χ²＝23.280；P值均<0.05。27例中行宫腔镜电切术7例，其中2例因术中出血较多，转为开腹手术。开腹行病灶切除加修补术8例，行清宫术9例，其中单纯行清宫2例，2例术中出现大出血而紧急子宫动脉化疗栓塞术(UACE)，其他5例则用甲氨蝶呤(MTX)治疗或UACE后行清宫术。行UACE 14例，其中13例UACE联合清宫术或宫腔镜或术后MTX治疗。单纯MTX药物治疗2例。27例均治愈，无子宫切除病例。 结论剖宫产瘢痕妊娠较少见，临床容易误诊，治疗应根据患者血HCG水平、病灶大小、部位、表面肌层厚度、血流、阴道流血情况等进行综合评价，选择个体化治疗方案，必要时几种治疗方法联合应用。

Cesarean scar pregnancy analysis of 27 cases

ObjectiveTo investigate the suitable measures of diagnosis and treatment of cesarean scar pregnancy (CSP). MethodsThe clinical data of 27 patients with CSP in Sun Yat-sen Memorial Hospital from 2005 to 2011, including disease history, clinical presentation, the process of diagnosis and treatment and the outcome of patients were analyzed retrospectively. The gravidity, parity, duration since prior cesarean section, menopause days and HCG level between two groups were compared using Student's t test. Case of laparotomy and case of mass type found by ultrasound between two groups were compared using Chi-Square test. ResultsAmong 27 cases, 13 cases were transferred to our hospital because of incontrollable vaginal bleeding. Other 14 cases were treated in our hospital firstly. Menopause days (57.1±17.8) vs (83.5±28.4), t=2.910; laparotomy (1 vs 7, χ²=7.05); case of mass type found by ultrasound (1 vs 13, χ²=3.28); all P<0.05. Among the 27 cases, hysteroscopy electro-resection was applied in 7 cases, and 2 cases performed laparotomy due to more bleeding. Eight patients were treated by local resection and uterine repair by laparotomy. Curettage was applied in 9 cases, 2 cases of which underwent uterine artery chemoembolism(UACE) due to the severe vaginal bleeding. Five cases of which underwent curettage after MTX treatment or UACE. UACE was applied in 14 patients, 13 cases of which were combined with curettage or hysteroscopy or MTX treatment. MTX without other treatments was applied in 2 cases. 27 patients were cured successfully without any case of hysterectomy. ConclusionsCSP is rare and usually misdiagnosed. The treatment of CSP should be based on blood HCG levels and lesion size, location, muscle thickness of surface, blood flow and vaginal bleeding. Individual therapy is recommended. Combined treatment may be needed in some conditions.