摘要
目的探讨剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的诊治方法。方法回顾性分析2014年1月~2016年12月我院首诊的83例CSP的临床资料。79例超声确诊,2例MRI确诊,2例(2.4%)漏诊。其中11例无预处理直接彩超监测下清宫术(按中华医学会2016年分型,Ⅰ型10例,Ⅱ型1例),34例甲氨蝶呤(methotrexate,MTX)预处理24小时后行彩超监测下清宫术(Ⅰ型30例,Ⅱ型4例),37例子宫动脉栓塞(uterine artery embolization,UAE)预处理24小时后行彩超监测下清宫术(Ⅰ型3例,Ⅱ型30例,Ⅲ型4例),1例UAE预处理后24小时行腹腔镜监测下清宫术(Ⅲ型)。结果手术均获成功,无中转开腹及子宫切除,无持续性妊娠。术后随访65例,β-h CG降至正常时间2~5周,月经恢复时间4~9周。结论根据孕周、分型采取不同预处理方式联合清宫术治疗CSP简单、安全、有效,是适合基层医院的理想方法。
Objective To explore the clinical diagnosis and treatment of cesarean scar pregnancy（CSP）. Methods The clinical data of 83 CSP patients who first visited to our hospital during the period from January 2014 to December 2016 were collected for a retrospective analysis. Among the 83 cases,79 were diagnosed by ultrasound,2 were diagnosed by MRI,and 2 were misdiagnosed（2. 4%）. Curettage under ultrasound monitoring was used in 11 cases,including 10 cases of type Ⅰ and 1 case of typeⅡ according to the 2016 classification standard of Chinese Medical Association. Curettage under ultrasound monitoring after methotrexate（MTX） was used in 34 cases,including 30 cases of type Ⅰ and 4 cases of type Ⅱ. Curettage under ultrasound monitoring after uterine artery embolization（UAE） was used in 37 cases,including 3 cases of type Ⅰ,30 cases of type Ⅱ,and 4 cases of typeⅢ. Besides,1 case of type Ⅲ was treated with curettage under laparoscopic monitoring after UAE. Results All the operations were successful,without hysterectomy or conversion to open surgery. No persistent pregnancy was occurred. A total of 65 cases were followed up and 18 cases were lost. The β-h CG was decreased to normal after 2-5 weeks. After 4-9 weeks,menstruation was recovered. Conclusion According to different clinical types of CSP and gestational weeks,curettage under ultrasound or laparoscopic monitoring after different pretreatement is simple,safe and effective in primary hospitals.
出处
《中国微创外科杂志》
CSCD
北大核心
2017年第4期314-316,共3页
Chinese Journal of Minimally Invasive Surgery
基金
北京市通州区科委课题(项目编号Kj2015CX004-12)
关键词
剖宫产瘢痕妊娠
预处理
子宫动脉栓塞术
甲氨蝶呤
清宫术
Cesarean scar pregnancy
Pretreatment
Uterine artery embolization
Methotrexate
Curettage
