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目的分析剖宫产切口妊娠(caesarean scar pregnancy,CSP)的临床治疗策略和效果,为临床上合理并个体化诊治该疾病提供资料。方法回顾性分析复旦大学附属妇产科医院收治的76例CSP患者的临床资料,针对该疾病临床发病特点、诊断、治疗策略及效果进行剖析。结果 CSP临床表现多见停经、不同程度的阴道出血和血β-hCG水平升高。35例患者行子宫动脉栓塞(UAE)+腹部B超引导下清宫术,20例患者行UAE后宫腹腔镜联合手术,9例患者行UAE后宫腔镜手术,6例患者行MTX+腹部B超引导下清宫术,4例患者行米非司酮+腹部B超引导下清宫术,2例患者经腹病灶切除+修补术。有2例患者因大出血中转经腹手术,1例行全子宫切除。所有患者均好转或痊愈出院。结论 CSP有可能导致子宫大出血甚至危及生命,临床应加以重视,及时发现并行子宫动脉栓塞术,再选择合适手术至关重要,宫腔镜术安全有效且最为微创,当妊娠物极近浆膜层时,可考虑宫腹腔镜联合手术。
Objective To analyze the clinical treatment strategy and effect of caesarean scar pregnancy (CSP) and provide information for clinically reasonable and individualized treatment of the disease. Methods The clinical data of 76 CSP patients admitted to Obstetrics and Gynecology Hospital of Fudan University were retrospectively analyzed. The clinical features, diagnosis, treatment strategies and effects were analyzed. Results Clinical manifestations of CSP more common menopause, varying degrees of vaginal bleeding and blood β-hCG levels. Thirty-five patients underwent uterine artery embolization (UAE) plus abdominal B-ultrasonography undergoing hysteroscopic surgery. Twenty patients underwent UAE hysteroscope laparoscopic surgery. Nine patients underwent UAE hysteroscopic surgery. Six patients underwent MTX plus abdominal B- Qing surgery, 4 patients underwent mifepristone + abdominal B-guided radical hysteroscopy, 2 patients by abdominal lesion resection + repair. There were 2 cases of transhepatic hemorrhage due to abdominal surgery, 1 case of hysterectomy. All patients were improved or discharged. Conclusion CSP may cause bleeding or even endanger the life of the uterus, the clinical should pay attention to the timely detection of parallel uterine artery embolization, and then select the appropriate surgery is crucial, hysteroscopy is safe and effective and most minimally invasive, when the pregnancy is very close to the serosa Layers, may consider laparoscopic laparoscopic surgery.