48例剖宫产瘢痕妊娠诊治分析

目的:探讨剖宫产瘢痕妊娠(CSP)的临床特点、早期诊断及治疗方法。方法:对本院2006年7月-2016年10月收治的48例确诊为CSP患者的临床资料进行回顾性分析。结果:所有患者术前均行彩色多普勒阴道超声(TVS)检查,46例术前明确诊断,2例术中确诊。48例患者中23例行双侧子宫动脉栓塞术联合甲氨蝶呤化疗及清宫术,17例行B超监视下清宫术或直接清宫术,7例行宫腔镜下病灶切除术,1例行经阴道妊娠病灶切除术和子宫瘢痕修补术,所有病例均成功保留了子宫。结论:阴道超声是CSP首选确诊方法,早期发现可保守治疗;治疗应个体化,微创手术能最大程度地降低损伤,保护患者的生育能力,切忌盲目刮宫。

Analysis of diagnosis and treatment of 48 patients with cesarean scar pregnancy

Objective:To discuss the etiological factor,clinical characteristics,early diagnosis and treatment methods of cesarean scar pregnancy(CSP).Methods:48 patients with CSP in Beijing Haidian Hospital between July 2006 and October 2016 were retrospectively analyzed.Results:All patients received transvaginal color Doppler ultrasonography examination before operation.46 of them were final diagnosed,and the diagnosis rate was 95.8％.Among them,23 patients had been interventional chemotherapy and uterine artery embolization(UAE) combined with curettage,7 patients received hysteroscopy and lesion excision,15 patient got ultrasound guided curettage,2 patient got direct dilatation and curettage,and 1 patient got transvaginal surgery and lesion excision.All patients had received conservative treatment successfully,and their fertility was preserved.Conclusion:Transvaginal ultrasound is a preferred diagnostic method for patients with CSP.Most patients diagnosed early can preserve their fertility by conservative treatment successfully,and treatment should be individualized.The microinvasive operation is important for patients with CSP,which can minimize lesion dimensions,and maximally retain their fertility.Blind curettage should be avoided.