剖宫产瘢痕妊娠39例临床诊疗分析

目的:总结剖宫产瘢痕妊娠(CSP)的临床特点,探讨CSP的早期正确诊断方法及恰当的治疗方法。方法:回顾性分析2002年1月至2009年2月我院收治的39例剖宫产瘢痕妊娠患者临床资料及临床诊疗经过。结果:患者的平均年龄是31.5±5.0岁,均有子宫下段剖宫产史。患者均有停经史,26例发生停经后阴道点滴到中度流血。28例误诊为正常早孕或难免流产而行人流或药流,2例阴道大出血急行剖腹探查术,术后病理确诊,其余患者由彩色超声多普勒确诊,依据血β-HCG值高低分组采用米非司酮加甲氨蝶呤全身和/或局部应用的个体化治疗,两例另行子宫动脉栓塞术。患者均痊愈出院,随诊血β-HCG值至正常。结论:剖宫产术后子宫瘢痕妊娠临床表现缺乏特异性,容易误诊,应当加强对本病的认识,结合病史、查体及辅助检查以期早期诊断,可根据患者血β-HCG值选取不同的治疗方案。

Clinical analysis of the diagnosis and treatment of 39 cases of caserean scar pregnancy

Objective:To summarize the clinical characteristcs of caesarean scar pregnancy and to explore its early diagnosis and teratment.Methods:Clinical data of 39 cases of caesarean scar pregnancy from January 2002 to february 2009 were reviewed and analyzed.Results:The mean age of the women was 31.5±5.0 years.All cases had amenorrhoea and 26 cases had veginal bleeding from spotting to moderate.28 cases were misdiagnosed as normal early intrauterine pregnancy or inevitable miscarriage,and were treated with dilation and curettage or medical abortion.2 cases were given exploratory laparotomy for massive bleeding,and diagnosed by pathological report;others were diagnosed with ultrasonogram.According to blood β-HCG levels,given individual therapey with mifepristone and Methotrexate,2 cases separately treated with uterine artery embolization.All cases were cured and followed-up blood β-HCG to normal.Conclusion:Caesarean scar pregnancy is short of specificity and offen misdiagnosed.Early diagnosis can be made according to case history,gynecologic examination and auxiliary examinations,and cases can be given different therapeutic regimen in terms of the value of blood β-HCG.