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目的:探讨剖宫产子宫瘢痕部位妊娠(CSP)的早期诊断方法及评估子宫动脉灌注栓塞术用于治疗CSP的临床疗效。方法:回顾性分析2004年1月～2009年12月收治的52例CSP病例的临床表现、超声检查及治疗效果。结果:45例经彩超检查提示瘢痕妊娠,33例行子宫动脉灌注栓塞术,6例因β-hCG水平较低采用MTX治疗,5例因瘢痕部位破裂行病灶切除及子宫修补术,5例因瘢痕部位包块较大行开腹手术治疗,3例经腹腔镜探查明确诊断及手术治疗。术后监测血β-hCG于2～5周均降至正常水平。结论:彩色多普勒超声检查可用于早期诊断CSP,子宫动脉灌注栓塞术具有微创、止血迅速、病灶萎缩快等优点,对于CSP是一种安全有效的治疗方法。
Objective: To explore the early diagnosis of cesarean section uterine scar pregnancy (CSP) and evaluate the clinical efficacy of uterine artery embolization for the treatment of CSP. Methods: The clinical manifestations, sonographic findings and therapeutic effects of 52 CSP cases admitted from January 2004 to December 2009 were analyzed retrospectively. Results: 45 cases were diagnosed as hypertrophic scar by color Doppler ultrasound, 33 cases were treated with uterine arterial infusion and embolization, 6 cases were treated with MTX due to the low level of β-hCG, 5 cases were resected due to scar rupture and uterine repair. Surgical treatment of large cadaractic laparotomy in the scar site, 3 cases of laparoscopic exploration confirmed the diagnosis and surgical treatment. Postoperative blood β-hCG 2 to 5 weeks were reduced to normal levels. Conclusion: Color Doppler ultrasonography can be used for early diagnosis of CSP. Uterine artery embolization has the advantages of minimally invasive, rapid hemostasis and rapid atrophy of the lesion. It is a safe and effective treatment for CSP.