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目的:探讨剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的发病机制、早期诊断方法以及个体化的治疗方案。方法:回顾性分析2007年1月～2009年12月海淀区妇幼保健院收治的51例剖宫产瘢痕妊娠患者的临床资料,包括患者的发病年龄、孕周、剖宫产术至发病的间隔时间、首发症状、发病部位、诊疗过程、个体化的治疗方法及结局。结果:患者的平均年龄为31.1岁,48例有1次剖宫产手术史,3例有2次剖宫产手术史,此次妊娠距离前次剖宫产术后8个月～10年。32例主诉有停经史及阴道少量出血。17例无症状者彩超直接确诊瘢痕妊娠,1例误诊为早孕外院行刮宫术发生阴道大出血。1例误诊为稽留流产,共有49例治疗前确诊。通过剖宫产病史,妇科检查和血HCG、超声及MRI等辅助检查综合分析可明确诊断。治疗方法是根据彩超及血HCG值予以个体化治疗,包括米非司酮联合MTX全身药物保守治疗,或经米非司酮联合MTX全身药物保守治疗后,B超监测下行宫腔镜直视下刮宫术,术后予以球囊压迫宫腔止血。除1例转入外院,其余病例保守治疗均获成功,保留了生育功能。平均住院9天。结论:CSP的发病呈上升趋势,临床易误诊,早期诊断尤为重要。根据患者情况予以个体化治疗,可获得较好疗效。
Objective: To investigate the pathogenesis, early diagnosis and individual treatment of cesarean scar pregnancy (CSP). Methods: The clinical data of 51 cases of cesarean scar pregnancy admitted from January 2007 to December 2009 in Haidian Maternal and Child Health Care Center were retrospectively analyzed. Including the patients’ age at onset, gestational age, cesarean section to the interval of onset Time, first symptom, site of attack, diagnosis and treatment, individualized treatment and outcome. Results: The average age of patients was 31.1 years old, 48 cases had a history of cesarean section, 3 cases had 2 history of cesarean section, the pregnancy from the previous cesarean section after 8 months to 10 years. 32 cases complained of menopause and vaginal bleeding. Seventeen cases of asymptomatic ultrasound directly diagnosed with scar pregnancy, one case misdiagnosed as early pregnancy outside the hospital curettage vaginal bleeding occurred. One case misdiagnosed as missed abortion, a total of 49 cases diagnosed before treatment. Through cesarean section history, gynecological examination and blood HCG, ultrasound and MRI and other auxiliary examination comprehensive analysis can confirm the diagnosis. Treatment is based on ultrasonography and blood HCG values to be individualized treatment, including mifepristone combined with MTX systemic drug conservative treatment, or mifepristone combined with MTX systemic drug conservative treatment, B-monitoring under the hysteroscopy under direct vision Curettage, postoperative balloon compression of the uterine bleeding. In addition to one case transferred to the hospital, the remaining cases of conservative treatment were successful, retained the function of childbearing. The average hospital 9 days. Conclusion: The incidence of CSP is on the rise. It is very important to diagnose early and diagnose easily. According to the patient’s condition to be individualized treatment, get better curative effect.