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目的探讨剖宫产术后子宫瘢痕妊娠(cesareanscarpregnancy,CSP)的诊断及治疗方法。方法对北京协和医院1994～2004年收治的13例CSP患者临床资料进行回顾性分析。结果13例患者中10例诊断为宫内早孕行人工流产或药物流产。6例刮宫术中或术后发生大量阴道出血伴失血性休克。13例均经超声检查明确诊断。10例行子宫动脉栓塞(uterinearteryembolisation,UAE)的患者均迅速有效的控制了阴道出血并减少了术中出血,其中9例患者栓塞后联合药物、手术或期待治疗均成功的保留了生育功能,仅1例因合并子宫肌瘤要求行全子宫切除术;3例单纯甲氨蝶呤(MTX)保守治疗,2例成功,1例治疗失败行开腹局部病灶切除术。结论超声是诊断CSP的简便可靠方法。子宫动脉栓塞可以迅速止血,栓塞后联合药物或手术治疗是可选择的安全有效的治疗方法,单纯MTX保守治疗的安全性及有效性有待进一步观察。
Objective To investigate the diagnosis and treatment of cesarean scar pregnancy (CSP) after cesarean section. Methods The clinical data of 13 CSP patients admitted to Peking Union Medical College Hospital from 1994 to 2004 were retrospectively analyzed. Results Of the 13 patients, 10 cases were diagnosed as intrauterine abortion in the early pregnancy induced abortion or medical abortion. 6 cases of curettage or postoperative massive vaginal bleeding with hemorrhagic shock. Thirteen cases were confirmed by ultrasonography diagnosis. All 10 patients undergoing uterinearterial embolization (UAE) were able to control vaginal bleeding quickly and effectively and reduce intraoperative bleeding. Nine of them successfully retained their fertility after combination therapy, surgery or expectant treatment One patient underwent hysterectomy due to combined uterine fibroids. Three patients were treated with methotrexate (MTX) conservatively, two were successful and one patient underwent local laparotomy. Conclusion Ultrasound is a simple and reliable method to diagnose CSP. Uterine artery embolization can quickly stop bleeding, embolization combined with drug or surgical treatment is an optional safe and effective treatment, the safety and efficacy of simple MTX conservative treatment needs further observation.