子宫疤痕部位妊娠诊治14例回顾性分析

目的回顾分析我院14例子宫剖宫产疤痕部位妊娠（CSP）的诊断及治疗经过,探讨适宜CSP的治疗方案。方法主要根据病史采集、妇科检查、彩色超声检查、血清β-HCG等进行诊断。依据病情采用米非司酮口服、甲氨蝶呤肌注或病灶局部注射、清宫术及子宫动脉栓塞术等综合治疗方案。结果14例患者保守治疗成功,无需开腹及腹腔镜手术。结论有剖宫产史的妇女妊娠后应尽早B超检查,一旦确诊CSP,局部病灶注射MTX为首选及有效的方法,亦可根据病情采用药物保守治疗、清宫术或子宫动脉栓塞术等。

Diagnosis and treatment of pregnancy in the cesarean scar

Objective To study the diagnosis and treatment of pregnancy in a previous cesarean scar, and hence to explore the best treatment of this disease. Methods The clinical data of 14 patients with cesarean scar pregnancy （CSP） were analyzed retrospectively, the diagnosis was made according to the medical history, pelvic examination, ultrasound and serum beta - HCG. The treatment included intramuscular injection of methotrexate （MTX）, Injecting MTX locally, taking mifepristone orally, complete curettage of the uterine cavity and uterine artery embolization. Results The conservative treatment of the 14 cases were successful, needless of laparotomy and laparoscopy. Conclusion The patients who have history of previous caesarean section should take ultrasound as soon as possible when they are conceived, once diagnosed, local injection of MTX is proved to be the primary treatment, the drug and expectant therapy, uterine artery embolization, and complete curettage of the uterine cavity could also be considered individually according to medical history.