剖宫产术后子宫瘢痕妊娠11例分析

目的:探讨剖宫产术后子宫瘢痕妊娠的早期诊断和恰当的处理方法。方法:回顾性分析11例剖宫产术后子宫瘢痕妊娠患者的临床资料。结果:11例仅2例人工流产前诊断明确。其余9例中有3例表现人工流产术中大出血,6例表现为术后阴道大出血。11例均经超声检查明确诊断。其中8例行子宫动脉栓塞术(UAE)加甲氨蝶呤(MTX)灌注化疗,栓塞术后7~10天行清宫术。无一例大出血发生,成功率100%。2例予MTX全身化疗后在B超引导下清宫,术中出血约400 ml。1例予米非司酮口服后清宫术中大出血而改行UAE。结论:超声检查特别是阴道超声检查,是诊断剖宫产术后子宫瘢痕妊娠的主要方法,UAE加MTX灌注化疗是首选的、有效的治疗方法。

Clinical analysis of cesarean scar pregnancy:report of 11 cases

Objective：To explore the early diagnosis and pertinent treatment of cesarean scar pregnancy（CSP）. Methods：The clinical data of eleven patients with CSP were analyzed retrospectively. Results ： Among the eleven eases, only 2 cases had clear diagnosis before artificial abortion. Three cases had uterine rupture and massive hemorrhage during artificial abortion. Six cases had vaginal massive hemorrhage after artificial abortion. All of them were diagnosed by colored B-ultrasound, Among the eleven cases, eight eases were treated by uterine artery embolization（UAE） combination with methotrexate（MTX） and had curettage 7 - 10 days after UAE. No case had the occurence of massive hemorrhage. All of them were successful. Two cases were treated with MTX and eurratage with the help of ultrasound. There was about 400 ml bleeding during operation in every case. Only one case was treated by oral mifepristone and there was treated again by UAE because of massive hemorrhage during curettage. Conclusions：Color B-ultrasound, especially color Doppler transvaginal uhrasonography is the main method in diagnosis of CSP. UAE combination with MTX is one of the best effective treatment.