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目的探讨剖宫产瘢痕部位妊娠(CSP)的临床特点、诊断与治疗。方法收集54例CSP患者临床资料,对其诊断、治疗方法及结局进行回顾性分析。结果 54例患者中位年龄31.5岁,均有一次剖宫产手术史,剖宫产手术与本次妊娠时间间隔平均6.0年。多数无特异的临床表现,外院误诊转入13例,误诊患者发生大出血4例。阴道超声是诊断CSP的主要方法。54例患者中,4例患者手术治疗,50例患者行保守治疗,其中甲氨蝶呤(MTX)治疗后清宫19例,3例效果不佳加行子宫动脉栓塞术(UAE)+子宫动脉MTX灌注化疗;UAE后清宫9例;UAE联合MTX 22例。所有保守治疗患者治疗均成功,手术患者无并发症发生。结论彩色多普勒超声是诊断CSP的重要方法;早期诊断和治疗对CSP病程进展和转归有重要意义;对不同CSP患者应选择个体化的治疗方案,MTX治疗后清宫和动脉介入治疗后清宫是治疗CSP比较有效的保守方法,手术治疗主要是病灶切除术。
Objective To investigate the clinical features, diagnosis and treatment of cesarean scar pregnancy. Methods The clinical data of 54 patients with CSP were collected and the diagnosis, treatment and outcome were retrospectively analyzed. Results The median age of 54 patients was 31.5 years old. All had a history of cesarean section operation. The average time between cesarean section operation and this pregnancy was 6.0 years. Most non-specific clinical manifestations, misdiagnosed outside the hospital transferred to 13 cases, misdiagnosed patients with massive bleeding in 4 cases. Vaginal ultrasound is the main method of diagnosis of CSP. Of the 54 patients, 4 were treated surgically and 50 were treated conservatively. Among them, 19 were cured by methotrexate (MTX) and 3 were ineffective with uterine artery embolization (UAE) and uterine artery MTX Perfusion chemotherapy; UAE after the Qing 9 cases; UAE combined MTX 22 cases. All conservative treatment of patients were successful, surgical patients without complications. Conclusions Color Doppler ultrasonography is an important method for the diagnosis of CSP. Early diagnosis and treatment are of great significance for the progression of CSP and prognosis. Individualized treatment regimens should be selected for different CSP patients. After the intervention of Qingxu and arterial interventions, CSP is more effective treatment of conservative methods, surgical treatment is mainly focal resection.