剖宫产瘢痕妊娠早期诊治方法的探讨——附47例临床分析

目的：探讨剖宫产瘢痕妊娠（cesarean section pregnancy，CSP）早期诊断及治疗方法，为临床诊治提供参考。方法：分析1998年1月—2008年12月收治的47例确诊为CSP的病例，诊断主要依靠超声检查、全子宫切除标本及病理检查。治疗主要选择2种方法：①在超声引导下妊娠囊穿刺术+甲氨蝶呤（MTX）囊内注药，适时行清宫术。②子宫动脉栓塞术，配合静脉MTX治疗，适时行清宫术。结果：47例中第1种方法治疗27例，失败2例；第2种方法治疗20例，失败5例。治疗失败7例患者均因反复阴道大量出血，最终切除子宫。结论：CSP应早期诊断，选择适当的个体化治疗方法可提高治疗成功率。

A Probe into Early Treatment Methods for CSP(with Clinical Analysis of 47 Cases)

Objective: To explore the early diagnosis and treatment of Cesarean scar pregnancy（CSP） to provide basis for clinical diagnosis and treatment. Method: 47 cases from Jan. 1998 to Dec. 2008 diagnosed as CSP were reviewed， and the diagnoses were mainly by means of ultrasonic examination， total hysterectomy specimens and pathological examination; Two methods were mainly selected for the treatment which were:① ultrasonic guided gestational sac puncture with Methotrexate（MTX）+intra-sac injection and dilatation and curettage performed at a suitable time ②uterine artery embolism in combination with intravenous MTX treatment and dilatation and curettage performed at a suitable time. Result: Of the 47 cases， 27 cases selected the first method and 20 cases selected the second method which showed 2 failed and 5 failed， respectively. In the 7 failing cases， the patients eventually received hysterectomy because of repeated massive vaginal bleeding. Conclusion: CSP should be diagnosed early， and suitable individualized treatment regimes may increase the successful rate of treatment.