剖宫产瘢痕部位妊娠12例临床分析

目的：探讨剖宫产瘢痕部位妊娠（CSP）的临床特点及诊治方法.方法：回顾性分析2008-2013年内蒙古民族大学附属医院妇产科收治的剖宫产瘢痕部位妊娠病例共12例的临床资料.结果：1例患者因急性腹痛伴休克急诊开腹手术.9例患者给予米非司酮和/或甲氨蝶呤杀胚治疗后清宫.2例转外院，在子宫动脉介入栓塞后清宫；其中1例因大出血而行子宫切除术.结论：剖宫产瘢痕部位妊娠常出现停经后不规则阴道出血、药流时不全流产、人流或清宫时大量出血、子宫前壁下段不均质包块、清宫及流产后HCG持续不降、急性腹痛伴腹腔内大出血休克等症状.阴道超声对于剖宫产瘢痕部位妊娠的诊断起到至关重要的作用.给予米非司酮和/或甲氨蝶呤杀胚治疗后再清宫是基层医院治疗剖宫产瘢痕部位妊娠的有效方法，必要时可以开腹手术，有条件的医院可以采取子宫动脉介入栓塞后清宫.

Clinical Analysis of 12 Cases of Cesarean Scar Pregnancy

Objective：To investigate the clinical features, diagnosis and treatment methods of cesarean scar pregnancy （CSP）. Methods：The clinical data of 12 cases of CSP who were treated in gynecology department in Affiliated Hospital of Inner Mongolia University for Nationalities from 2008 to 2013 were retrospectively analyzed. Results：One patient underwent emergency laparotomy due to acute abdominal pain accompany with shock;9 cases were treated with mife-pristone and/or methotrexate to kill the embryos, and then underwent curettage; 2 cases went to other hospital, they were treated with curettage after uterine artery interventional embolization;one of which underwent hysterectomy be-cause of massive hemorrhage. Conclusion： CSP often appear the symptoms such as irregular vaginal bleeding after menopause, incomplete abortion of drug flow, heavy bleeding during abortion or curettage, heterogeneity masses in the anteroinferior wall of uterine, HCG continuously not fall after curettage and abortion, acute abdominal pain accompany with intra-abdominal massive hemorrhage shock and so on. Transvaginal ultrasound plays a crucial role for the diagno-sis of CSP. The effective method for primary hospital to treat CSP is applying mifepristone and/or methotrexate to kill the embryo, and then curettage method, if necessary adopting laparotomy;the conditional hospital can adopt curettage after uterine artery interventional embolization.