摘要
目的 探讨剖宫产瘢痕妊娠（CSP）的临床诊治.方法 回顾性分析2003年1月至2011年3月北京大学第一医院收治的100例CSP患者的临床资料.结果 100例CSP患者中,45％无症状,55％有阴道出血,其中7％合并下腹痛；北京大学第一医院首诊81例,确诊75例,误诊6例；外院转诊19例中,18例确诊,1例误诊为绒癌.100例患者中,子宫动脉栓塞术（UAE）后超声监视下清宫56例,单纯超声监视下清宫术30例,UAE后和单纯腹腔镜下病灶切除各2例,全子宫切除术2例,甲氨蝶呤保守治疗3例,UAE止血3例,尿管球囊压迫止血2例.UAE联合清宫组和单纯清宫组的妊娠时间、清宫术中出血量和手术时间,差异无统计学意义,但单纯清宫组的孕囊直径、血清β人绒毛膜促性腺激素（β-HCG）水平明显小于UAE组,孕囊与膀胱间的肌壁厚度明显大于UAE组；单纯清宫术组96.7％为内生型,且仅36.7％见少量血流信号.100例患者均痊愈出院,随访43例UAE组和26例清宫组患者,两组患者均月经正常.8例再次妊娠（两组各4例）,1例再次发生CSP行甲氨蝶呤加清宫治疗.结论 早期诊断、早期治疗是成功治疗CSP的关键,彩色超声检查利于早期诊断并可指导治疗及监测疗效,应根据患者的具体情况行给予个体化治疗.
Objective To explore the clinical diagnosis and treatment of cesarean scar pregnancy （CSP）.Methods The clinical data of 100 CSP patients during the period of January 2003 to March 2011 were collected for a retrospective analysis.Results Among 100 cases of CSP,there were cases of asymptomatics（45%,n =45）,vaginal hemorrhage（55%,n =55）and lower abdominal pain（7%,n =7）; among first diagnosed（n =81）,the cases were diagnosed（n =75）or misdiagnosed（n =6）; among19 hospital referrals,18 were confirmed and 1 case was misdiagnosed as choriocarcinoma.Treatments included ultrasound monitoring curettage after UAE（uterine artery embolism）（n =56）,pure ultrasound monitoring curettage（n =30）,laparoscopic lumpectomy after UAE（n =2）,laparoscopic Iumpectomy（n =2）,methotrexate only（n =3）,hysterectomy（n =2）,UAE hemostasis（n =3）and Foley catheter balloon compression hemostasis（n =2）.No significant difference was found in the average duration of pregnancy,average operative hemorrhage volume and operative duration between 2 management groups of curettage after UAE or pure curettage（P 〉 0.05）.But sac diameter and serum level of β-HCG were obviously less in the pure curettage group than those in the UAE group.And the distance between gestation sac and bladder significantly was greater than that in the UAE group; in the pure curettage group,96.7% existed as an endogenous type and only 36.7% yielded small flow signals.One hundred patients recovered before discharge.A follow-up of patients with curettage after UAE（n =43）and pure curettage（n =26）had similar recovery of menstruation.Eight cases（4 in each）were pregnant again during the follow-up.One case of recurrent CSP was treated with curettage after methotrexate.Conclusion Early diagnosis and early treatment remain the key for a successful treatment of CSP.Color Doppler ultrasound is important in its early diagnosis and treatment.Different therapeutic modalities may be selected according to specific patient cond
出处
《中华医学杂志》
CAS
CSCD
北大核心
2011年第45期3186-3189,共4页
National Medical Journal of China
关键词
剖宫产瘢痕妊娠
子宫动脉栓塞术
清宫术
超声监视
Cesarean scar pregnancy
Uterine artery embolism
Curettage
Ultrasound monitoring
