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目的探讨剖宫产术后瘢痕处妊娠(CSP)的临床特点、诊断及治疗方法。方法对36例CSP患者的临床资料进行回顾性分析。结果 36例患者均有剖宫产史,至少1次,HCG<2000mIu/ml者10例患者采用常规MTX保守药物治疗加刮宫术,均获成功。9例行B超引导下局部抽吸妊娠囊液+局部注入MTX,24～48小时后清宫成功7例,2例因在清宫术中大出血,均急诊行子宫动脉栓塞治疗;HCG>100000mIu/ml者17例有3例患者因为人工流产术而导致大出血急诊子宫动脉栓塞治疗,14例患者均行双侧子宫动脉栓塞+MTX灌注+刮宫术成功。结论应提高临床医生对CSP的认识,CSP一般超声检查可确诊,子宫动脉栓塞+刮宫术可做为首选治疗方案。
Objective To investigate the clinical characteristics, diagnosis and treatment of pregnancy after cesarean section (CSP). Methods The clinical data of 36 patients with CSP were retrospectively analyzed. Results All the 36 patients had a history of cesarean section. At least one time, 10 patients with HCG <2000mIu / ml were treated with conventional MTX conservative drug therapy plus curettage, all of which were successful. Nine patients underwent B-ultrasound guided local injection of gestational sac fluid + local injection of MTX, 24 to 48 hours after the success of the curettage in 7 cases, 2 cases due to bleeding in the curettage, emergency line uterine artery embolization; HCG> 100000mIu / ml Among the 17 patients, there were 3 patients who suffered from massive haemorrhage due to induced abortion and had uterine arterial embolization. All 14 patients underwent successful bilateral uterine artery embolization plus MTX perfusion and curettage. Conclusion Clinicians should raise awareness of CSP, CSP can be diagnosed by general ultrasound, uterine artery embolization + curettage can be used as the preferred treatment.