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目的:探讨剖宫产瘢痕妊娠(CSP)的合理治疗方案。方法:回顾性分析2007年1月至2013年12月我院收治的26例CSP患者的临床资料,对其病史、临床表现、处理及结局进行总结分析,重点探讨其治疗方案与预后的关系。结果:采用的治疗方式包括口服米非司酮配伍米索前列醇后超声监测下清宫术6例、超声监测下局部甲氨蝶呤注射3例、全身甲氨蝶呤注射后清宫术2例、子宫动脉(化疗)栓塞后清宫术16例、经腹病灶切除术1例、经腹全子宫切除术1例。前三种方法尽管具有一定的成功率,但均有较高的术后大出血风险。子宫动脉(化疗)栓塞在CSP的初始及抢救治疗中均具有很高的成功率。结论:CSP治疗方案的选择需根据患者的病情、妊娠部位、生育要求等多方面进行综合考虑。在现有的治疗方案中,子宫动脉(化疗)栓塞后清宫术具有较大的优势。
Objective: To investigate the reasonable treatment of cesarean scar pregnancy (CSP). Methods: The clinical data of 26 CSP patients admitted to our hospital from January 2007 to December 2013 were retrospectively analyzed. The history, clinical manifestation, treatment and outcome were summarized and analyzed. The relationship between the treatment regimen and prognosis was discussed. Results: The treatment methods included oral administration of mifepristone and misoprostol under ultrasound monitoring under the curettage in 6 cases, ultrasound monitoring of local methotrexate injection in 3 cases, systemic methotrexate after curettage in 2 cases, Uterine artery (chemotherapy) 16 cases of curettage after embolization, Abdominal resection in 1 case, abdominal hysterectomy in 1 case. Although the first three methods have a certain success rate, but have a higher risk of postoperative bleeding. Uterine artery (chemotherapy) embolization in CSP initial and rescue treatment have a very high success rate. Conclusion: The choice of CSP treatment plan should be based on the patient’s condition, pregnancy site, reproductive requirements and other aspects of comprehensive consideration. In the existing treatment options, uterine artery (chemotherapy) after the curettage has a greater advantage.