剖宫产瘢痕妊娠的诊断及处理

目的:探讨剖宫产瘢痕妊娠的发病机制、早期诊断以及恰当的治疗方法。方法:回顾分析1994年1月至2006年5月北京协和医院收治的25例剖宫产瘢痕妊娠患者的临床资料,包括:患者的发病年龄,孕产次,发病至剖宫产术的间隔时间,首发症状,发病部位,诊断过程,辅助检查、治疗方法,经过及结局。结果:剖宫产瘢痕妊娠占同期异位妊娠的1.1%,与同期正常妊娠数之比为1:1368。25例患者的平均年龄31.4岁,92%的患者仅有一次剖宫产手术史,发病至末次剖宫产术的间隔时间为4月至15年,最常见的临床表现为停经和阴道流血,其中11例发生阴道大出血。16例(64%)患者分别误诊为宫内早孕(14例)和滋养细胞肿瘤(2例)而给予相应处理,仅9例治疗前确诊。通过剖宫产病史,妇科检查和超声、磁共振等辅助检查综合分析可作出诊断。治疗方法包括全子宫切除和保守性治疗(全身或孕囊内甲氨蝶呤注射和保守性手术)。25例患者均治愈出院。结论:剖宫产瘢痕妊娠较少见,临床易误诊,对有剖宫产手术史的患者应结合妇科检查及辅助检查以早期诊断,强调根据患者情况予以个体化治疗,可获得较好疗效。

Diagnosis and treatment of cesarean scar pregnancy

Objective:To explore the pathogenesy,early diagnosis and pertinent treatment of cesarean scar pregnancy.Methods:The clinical data of twenty-five patients with cesarean scar pregnancy (CSP) in Peking Union Medical College Hospital (PUMCH) from 1994 to 2006,including age of the patients,the interval from the last cesarean delivery to diagnosis,the clinical presentation,the location of the disease,the process of diagnosis and treatment,the outcome of the patients,were analyzed retrospectively using SPSS11.0 software.Results:Between 1994 and 2006,2322 ectopic pregnancies were treated in PUMCH,twenty-five of them had CSP (1.1%).The incidence of this condition in this hospital was 1:1368 normal pregnancies.The mean age of the group was 31.4 years.92% of the women had only one prior cesarean delivery.The interval from the last cesarean delivery to diagnosis ranged from four months to fifteen years.The most common presenting symptoms of CSP were amenorrhea and vaginal bleeding.Severe vaginal bleeding occurred in eleven cases.Fourteen cases were misdiagnosed as intrauterine early pregnancies and two were misdiagnosed as gestational trophoblastic neoplasia (GTNs).The rest nine were diagnosed definitely before treatment.The diagnosis was made through cesarean delivery history,gynecologic examination,ultrasonogram and magnetic resonance imaging (MRI).The treatment of this condition was variable,including hysterectomy,systemic or local methotrexate therapy and conservative surgery.All of the 25 women were cured after individual therapies.Conclusion:CSP is rare and usually misdiagnosed as other diseases.Early diagnosis of this condition is possible through aggregate analysis of prior cesarean delivery,gynecologic examination and relative auxiliary examinations.Individual therapy is recommended and considerable effect can be seen after it.