李云辉 戴红英 李伟伟 牛兆园 杨萌萌

[摘要]目的 评估超声引导下剖宫产瘢痕妊娠（CSP）清宫术的安全可行性及其影响因素。方法 回顾性分析2014年1月～2017年5月于青岛大学附属医院行超声引导下清宫术的129例CSP患者的临床资料，根据观察指标及评价标准分为成功组（n=118）与失败组（n=11），比较两组的孕龄、孕囊大小、术前血β-HCG、病灶处子宫前壁肌层厚度、术中出血量及清宫失败后的处理方法。结果 两组患者妊娠年龄、孕囊大小、术前血β-HCG的比较，差异均无统计学意义（P>0.05）。成功组的患者停经时间短于失败组，病灶处子宫前壁肌层厚度优于失败组，术中出血量少于失败组，差异均有统计学意义（P<0.05）。11例失败病例中，5例行开腹剖宫产瘢痕妊娠组织去除术；5例口服米非司酮药物保守治疗成功；1例因清宫术中大出血行动脉栓塞后行开腹剖宫产瘢痕妊娠组织清除术。结论 当CSP孕龄<7周，肌层厚度≥4.0 mm，行超声引导下清宫术安全性较高。对于清宫失败的CSP，如病灶局部血流信号丰富宜行手术治疗；如病灶局部血流信号不丰富，可行药物保守治疗。

[关键词]剖宫产瘢痕妊娠；清宫术；超声

[中图分类号] R714 [文献标识码] A [文章编号] 1674-4721（2018）5（a）-0123-03

[Abstract]Objective To evaluate the safety feasibility and influence factors of curettage for caesarean scar pregnancy under Ultrasound guided.Methods The clinical data of 129 patients with CSP who underwent ultrasound-guided curettage in affiliated hospital of Qingdao university from January 2014 to May 2017 were analyzed retrospectively.According to the observation index and evaluation criteria，the patients were divided into two groups：success group （n=118） and failure group（n=11）.The gestational weeks，gestational sac size，preoperative blood β-HCG，myometrial thickness of uterine anterior wall at focus，intraoperative blood loss and treatment methods after curettage failure were compared between the two groups.Results There was no significant difference in pregnancy age，gestational sac size and preoperative blood β-HCG between the two groups （P>0.05）.In the successful group，the time of menopause was shorter than that in the failed group，the thickness of myometrium in the lesion was better than that in the failed group，and the amount of intraoperative bleeding was less than that in the failed group，the difference was statistically significant（P<0.05）.Of the 11 failed cases，5 underwent cesarean scar pregnancy tissue removal.5 cases were successfully treated with mifepristone.One patient underwent cesarean scar pregnancy tissue removal after embolization due to massive hemorrhage during hysterectomy.Conclusion When CSP gestational age<7 weeks，thickness of muscle layer≥4.0 mm，underwent ultrasound guided curettage with high security.For the failed CSP of curettage，if the local blood flow signal is rich，the surgical treatment should be performed. If the local blood flow signal is not rich，the conservative treatment should be performed.

[Key words]Cesarean scar pregnancy；Curettage；Ultrasound

剖宮产瘢痕妊娠（caesarean scar pregnancy，CSP）是指胚胎着床于子宫前壁下段剖宫产瘢痕处，绒毛组织侵入瘢痕处向子宫浆膜面生长，限于早期妊娠（≤12周）。从1978年Larsen等[1]报道第1例CSP开始，近年来随着二胎政策放开、剖宫产指征放宽剖宫产率不断升高，CSP发病率也呈上升趋势，其发生率已达1/2216-/1800，占剖宫产病史妇女的1.15%[2]。CSP如不能及时诊治有危及生命的风险。回顾分析青岛大学附属医院行超声引导下清宫术129例CSP患者临床资料，分析超声引导下清宫术治疗CSP的安全性及可行性，现报道如下。

1 资料与方法

1.1 一般资料

回顾性分析2014年1月～2017年5月于青岛大学附属医院行超声引导下清宫术的129例CSP患者的临床资料，根据观察指标及评价标准分为成功组（n=118）与失败组（n=11），CSP诊断依据病史、临床表现、β-HCG及超声，确诊主要依靠阴道超声。C……