保守方法治疗剖宫产术后子宫瘢痕妊娠的结局

目的探讨剖宫产子宫瘢痕部位妊娠(CSP)的早期诊断方法,评估不同保守治疗方法的临床疗效。方法回顾性分析2000年1月至2011年9月收治的56例CSP病例的临床表现、超声检查及治疗效果。结果 56例患者中12例因血β-HCG值较低接受MTX全身用药,8例仅用药一次,4例一周后需重复用药。26例行B超引导下介入治疗后清宫,过程顺利。18例行子宫动脉灌注化疗栓塞术,2例失败行经腹子宫瘢痕处病灶切除,其余16例栓塞顺利后清宫出血不多。结论阴道超声可用于CSP的早期诊断。3种保守治疗方法均能有效治疗CSP。子宫动脉栓塞和B超引导下介入治疗具有安全、病灶萎缩快、出血少等优点。

The Result of Conservative Treatment for Cesarean Searpregnancy

Objective To explore the method of early diagnosis of cesarean searpregnancy,evaluate the clinical efficacy of different conservative treatment.Methods The clinical manifestations,ultrasonic examination and clinical efficacy of 56 case with cesarean searpregnancy who were treated in the hospital from january 2000 to september 2011 were analyzed retrospectively.Results 12 cases were treated with MTX because of low level of β-HCG,8 cases just used medicine once,4 cases must repeat medication after one week.26 cases had curettage and suction after ultrasonography guided intervention,were no event after opertion.18 cases received uterine arterial perfusion and embolization,2 cases were fail,and received laparotomy.16 cases had curettage and suction with litter bleeding.Conclusions ultrasonography can be used for early diagnosis of cesarean searpregnancy.Three kinds of conservative treatment are effect in treatment of cesarean searpregnancy.Uterine artery embolization and ultrasonography guided intervention have the advantages of safe,fast atrophy of focal lesion,litter bleeding.