CAJ | 학술논문

目的：探讨剖宫产切口瘢痕妊娠（CSP）的病因、诊断及治疗方法。方法回顾分析2010年1月～2013年12月我院妇科收治的11例CSP患者临床资料。结果11例患者停经40～75d，入院前无痛性阴道流血7例，大出血4例（3例为外院B超检查诊断为宫内孕，1例为我院诊断为难免流产）。11例患者均用甲氨蝶呤+米非司酮联合治疗，其中4例患者经药物保守治疗查血β-HCG降至正常后出院，7例药物治疗无效转入手术治疗（2例接受了病灶局部切除+子宫下段修补术，2例患者行双侧髂内动脉结扎术，3例年龄＞35岁、无生育要求者行全子宫次切除术）。7例手术患者术后1个月血β-HCG降至正常，恢复良好，病理证实子宫瘢痕妊娠。结论CSP临床较少见，易误诊，对有剖宫产术史的患者应尽早行阴道彩色多普勒超声检查，结合妇科检查及实验室检查早期明确诊断。
목적：탐토부궁산절구반흔임신（CSP）적병인、진단급치료방법。방법회고분석2010년1월～2013년12월아원부과수치적11례CSP환자림상자료。결과11례환자정경40～75d，입원전무통성음도류혈7례，대출혈4례（3례위외원B초검사진단위궁내잉，1례위아원진단위난면유산）。11례환자균용갑안접령+미비사동연합치료，기중4례환자경약물보수치료사혈β-HCG강지정상후출원，7례약물치료무효전입수술치료（2례접수료병조국부절제+자궁하단수보술，2례환자행쌍측가내동맥결찰술，3례년령＞35세、무생육요구자행전자궁차절제술）。7례수술환자술후1개월혈β-HCG강지정상，회복량호，병리증실자궁반흔임신。결론CSP림상교소견，역오진，대유부궁산술사적환자응진조행음도채색다보륵초성검사，결합부과검사급실험실검사조기명학진단。
Objective To investigate the pathogen, diagnosis and treatment methods of cesarean scar pregnancy(CSP). Methods Clinical data of 11 CSP patients admitted to the gynecology department of our hospital from January 2010 to December 2013 were analyzed retrospectively. Results All 11 patients underwent 40 to 75 days of menolipsis, of which 7 patients had painless vaginal bleeding prior to admission and 4 patients had massive haemorrhage(3 patients were diagnosed with intrauterine pregnancy by B-ultrasound in other hospitals and 1 patient was diagnosed with inevitable abortion in our hospital). All 11 patients received methotrexate+mifepristone combined treatment, of which 4 patients' β-HCG reduced to normal after conservative medication and they were discharged from hospital, and 7 patients' conservative medication was ineffective and they changed to operative treatment(2 patients received lesion local resection + lower uterine segment repair, 2 patients received bilateral internal iliac artery ligation, and 3 patients over 35 years old and with no fertility requirements received total hysterectomy surgery). Seven patients’blood β-HCG reduced to the normal level 1 month after surgery and they recovered well; Uterine scar pregnancy was confirmed by pathology. Conclusion CSP is clinically rare and prone to misdiagnosis. For patients with history of cesarean, vaginal color Doppler ultrasound should be conducted as early as possible and be combined to gynecological examination and laboratory tests for the purpose of early and accurate diagnosis.