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目的分析讨论剖宫产术后子宫切口瘢痕妊娠(cesarean scar pregnancy,CSP)的诊断及治疗方法。方法回顾性分析中山博爱医院2007年1月至2012年1月期间收治的42例CSP患者的临床资料。结果 18例行子宫动脉栓塞加灌注化疗及清宫术,在栓塞术后3～7d行超声监视下清宫术;11例在B超引导下行清宫术治疗;10例予甲氨蝶呤(methotrexate,MTX)保守治疗。7例行CSP病灶清除术,其中2例为清宫术中子宫大出血行腹式CSP病灶清除术,2例为药物保守治疗后仍大出血,行腹腔镜下CSP病灶清除术,3例行阴式CSP病灶清除术,术后复查血β-人绒毛膜促性腺激素(human chorionic gonadotrophin,HCG)下降明显,术中术后均未见并发症发生。术后血β-HCG降至正常的时间为14～56d,平均20.5d;月经恢复在治疗后30～68d,平均42.5d;B超检查包块消失的时间为3～6个月。结论早期及时诊断CSP,采取个体化治疗,以保留患者的生育功能。
Objective To analyze and discuss the diagnosis and treatment of cesarean scar pregnancy (CSP) after cesarean section. Methods The clinical data of 42 CSP patients admitted from January 2007 to January 2012 in Zhongshan Pok Oi Hospital were retrospectively analyzed. Results 18 cases of uterine artery embolization plus chemotherapy and curettage, 3 to 7 days after embolization under ultrasound monitoring of curettage; 11 cases of B-guided radical curettage; 10 cases of methotrexate (MTX )Conservative treatment. 7 cases of CSP lesions were removed, of which 2 cases of intrauterine curettage of uterine bleeding abdominal CSP lesions removal, 2 cases of bleeding after conservative treatment, laparoscopic CSP lesion removal, 3 cases of negative CSP Lesions and postoperative recurrent blood β-human chorionic gonadotrophin (HCG) decreased significantly, no postoperative complications were found. Postoperative blood β-HCG decreased to normal time for 14 ~ 56d, an average of 20.5d; menstruation recovery 30 ~ 68d after treatment, an average of 42.5d; B-ultrasound examination disappeared for 3 to 6 months. Conclusion Early diagnosis of CSP in time, to individualized treatment to retain the patient’s reproductive function.