剖宫产切口妊娠16例临床分析

目的探讨剖宫产切口妊娠(cesarean scar pregnancy,CSP)的临床特征及治疗方法。方法回顾性分析天津市蓟县人民医院自1990年~2010年收治的16例CSP患者的临床表现、诊断、治疗与结局。结果 16例患者的平均年龄33.5岁,前次剖宫产距此次发病时间为8个月到9年,平均5年,均为子宫下段横切口。16例患者均表现为阴道出血,其中12例有停经史,2例人工流产术后和2例药物流产术后阴道出血。通过临床表现、既往剖宫产术史、妇科检查和超声、实验室检查综合分析做出诊断。治疗方法主要包括甲氨喋呤注射液多剂肌肉注射法保守治疗、清宫术、局部病灶切除子宫修补术和全子宫切除术等。16例患者治疗后均恢复良好。结论 CSP临床较少见,易误诊,临床医生应密切关注有剖宫产史再次妊娠的患者,应结合妇科检查及影像学、实验室检查早期明确诊断,子宫动脉介入治疗同时配合甲氨蝶呤治疗为CSP的治疗提供了新的思路。

Clinical analysis of cesarean scar pregnancy in 16 cases

Objective To investigate the clinical manifestation and pertinent treatment for cesarean scar pregnancy.Methods The data from the clinical presentations,diagnoses,treatments and outcomes of 16 patients with CSP in Ji County People's Hospital in Tianjin City from 1990～2010-year were retrospectively analyzed.Results The average age of patients was 33.5 years.The interval from the last cesarean delivery to diagnosis ranged from 8 months to 9 years that average interval was 2 years.Lower uterine segment transverse incision was adopted in all patients.The most common symptoms of CSP were vaginal bleeding,with amenorrhea in12 patients,vaginal bleeding after artificial abortion in 2 patients and vaginal bleeding after medical abortion.The diagnosis was made through comprehensive analysis of data on cesarean delivery history,gynecologic examination,ultrasonograpy and magnetic resonance imaging.The therapies were mainly intramuscular injection with Methotrexate,Curettage,surgical removal and repair of the part of cesarean scar,hysterectomy.All of the 16 patients got good recovery.Conclusion CSP is rare and usually misdiagnosed.The early diagnosis should be made for the patients with cesarean delivery history by combination of gynecologic examination with laboratory detections.A new method-The Uterine artery intervention with methotrexate at the same time was provided for the therapy of CSP.