剖宫产瘢痕妊娠治疗方案的探讨

目的:探讨剖宫产瘢痕妊娠(CSP)的合理治疗方案。方法:回顾性分析2007年1月至2013年12月我院收治的26例CSP患者的临床资料,对其病史、临床表现、处理及结局进行总结分析,重点探讨其治疗方案与预后的关系。结果:采用的治疗方式包括口服米非司酮配伍米索前列醇后超声监测下清宫术6例、超声监测下局部甲氨蝶呤注射3例、全身甲氨蝶呤注射后清宫术2例、子宫动脉(化疗)栓塞后清宫术16例、经腹病灶切除术1例、经腹全子宫切除术1例。前三种方法尽管具有一定的成功率,但均有较高的术后大出血风险。子宫动脉(化疗)栓塞在CSP的初始及抢救治疗中均具有很高的成功率。结论:CSP治疗方案的选择需根据患者的病情、妊娠部位、生育要求等多方面进行综合考虑。在现有的治疗方案中,子宫动脉(化疗)栓塞后清宫术具有较大的优势。

The Analysis of the Treatment of Cesarean Scar Pregnancy

Objective:To investigate reasonable treatment method of cesarean scar pregnancy (CSP).Methods:26 cases of CSP were retrospectively analyzed in Guangdong No.2 Provincial People''s Hosptial, who were treated from 2007 January to 2013 December. The history, clinical manifestations, treatment and outcome of all the patients were summarized and analyzed, especially the relationship between treatment and prognosis were focused.Results:The treatment of CSP contained ultrasonic monitoring curettage after oral minfepristone and misoprotol in 6 cases, ultrasound guiding local methotrexate injection in 3 cases, systemic methotrexate injection combined curettage in 2 cases, uterine artery chemoembolization in 16 cases, transabdominal tumor resection in 1 case and transabdominal hysterectomy in another case. Although the first three methods had a certain success rate, a higher risk of postoperative hemorrhage indeed existed. Uterine artery chemoembolization had a high success rate in the initial and emergency treatment of CSP.Conclusion:The treatment of CSP should be comprehensively considered according to the patient''s condition, site of pregnancy, fertility requirements and so on. Among the existing therapies, uterine artery chemoembolization had a substantial advantage.