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目的探讨剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的早期诊断、治疗方法与预后。方法回顾性分析30例CSP患者的临床表现、超声诊断、治疗方式及随访资料。结果 30例CSP患者中,29例(96.67%)经阴道超声检查诊断。30例患者中,I型18例,Ⅱ型12例。18例Ⅰ型患者中,15例直接超声引导下行清宫术治疗,其中1例清宫术中大出血,行经腹子宫局部病灶切除术+子宫瘢痕修补术;3例行选择性子宫动脉栓塞术+清宫术。12例Ⅱ型患者中,9例采用天花粉或甲氨蝶呤杀胚治疗;3例行阴式子宫局部病灶切除术+子宫瘢痕修补术。30例患者均治疗成功,预后良好。结论剖宫产瘢痕妊娠的诊断依靠阴道超声检查,明确诊断后根据超声分型及临床表现选择合适的方式治疗。
Objective To investigate the early diagnosis, treatment and prognosis of cesarean scar pregnancy (CSP). Methods Retrospective analysis of 30 cases of CSP patients with clinical manifestations, ultrasound diagnosis, treatment and follow-up data. Results Of the 30 patients with CSP, 29 (96.67%) were diagnosed by transvaginal ultrasonography. Of the 30 patients, 18 were type I and 12 were type II. 18 cases of type Ⅰ patients, 15 cases under direct guided uterine curettage, including 1 case of bleeding during cesarean section underwent local abdominal hysterectomy + uterine scar repair; 3 cases of selective uterine artery embolization + curettage . Of the 12 patients with type II, 9 were treated with TCS or methotrexate; 3 patients underwent vaginal local excision of the uterus + uterine scar repair. All 30 patients were successfully treated and the prognosis was good. Conclusion The diagnosis of cesarean scar pregnancy rely on vaginal ultrasound examination, a clear diagnosis based on ultrasound and clinical manifestations choose the appropriate way to treat.