Atypical placental site nodule (APSN) is a rare benign gestational trophoblastic disease (GTD). It is a tumor-like transformation that has a certain probability of developing into a placental site trophoblastic tumor (PSTT) or epithelioid trophoblastic tumor (ETT). Because of its atypical clinical presentation, it is difficult to diagnose and susceptible to misdiagnosis highly, thus delaying the patient\'s condition. We report a scarce case of atypical nodules at the placental site of the uterine incision diverticulum in a 35-year-old female, who was irregular vaginal bleeding after a cesarean Sect. 2 years. She was diagnosed by several local hospitals with intrauterine residue and was given a variety of Traditional Chinese Medicine (TCM) orally, but the symptoms of irregular vaginal bleeding have not been alleviated. After being transferred to several hospitals, she went to Hubei Maternal and Child Health Hospital for treatment. Under the condition of excluding the second pregnancy, she underwent hysteroscopic resection of lesions and laparoscopic repair of uterine incision diverticulum. The pathological diagnosis after the operation suggested that the focus at the uterine incision was an atypical placental nodule that invaded the myometrium of the uterus. The operation completely removed the focus, and then the patient was followed up every 3 months in the first postoperative year, then every 6 months up to 3 years, and then annually thereafter up to 5 years, and then maybe every 2 years thereafter. The patient\'s condition was quickly controlled, and the prognosis was good.

OBJECTIVE: To observe the clinical therapeutic effect of the combination of electroacupuncture (EA) at Baliao points (bilateral Shangliao [BL 31], Ciliao [BL 32], Zhongliao [BL 33] and Xialiao [BL 34]) and oral administration of mifepristone tablets and its influence on uterine volume restoration after uterine curettage of incomplete abortion as compared with simple oral administration of mifeprstone tablets.
METHODS: A total of 58 patients after uterine curettage of incomplete abortion were randomized into an EA group and a western medication group, 29 cases in each one. In the western medication group, mifepristone tablets were administered orally, 2 tablets each time, once daily. In the EA group, on the base of the treatment as the western medication group, EA was applied to Baliao points, with disperse-dense wave, once daily, 50 min each time. The treatment for 3 days was as one course and 2 courses of treatment were required, at the interval of 1 day in the two courses. Before and after treatment, the area of intrauterine residue and blood flow signal positive rate of color Doppler flow imaging (CDFI) were recorded in patients of the two groups respectively. The days of vaginal bleeding and the rate of second operation were recorded after treatment in patients of the two groups. Using the three-dimensional ultrasound B reconstruction, the uterine endometrial volume after menstruation resumption was measured in patients of the two groups, and the clinical therapeutic effect was evaluated.
RESULTS: After treatment, the intrauterine residue area and CDFI blood flow signal positive rate were all reduced as compared with the values before treatment in patients of the two groups (P<0.05). After treatment, the intrauterine residue area and CDFI blood flow signal positive rate in the EA group were less than those in the western medication group (P<0.05). After treatment, the days of vaginal bleeding in patients of the EA group were less than that in the western medication group and the rate of second operation was lower than the western medication group (P<0.05). The uterine endomentrial volume after menstruation resumption in the EA group was larger than that in the western medication group after treatment (P<0.05). The total effective rate was 55.2% (16/29) in the EA group, higher than 37.9% (11/29) in the western medication group (P<0.05).
CONCLUSIONS: The combined treatment of electroacupuncture at Baliao points and oral administration of mifepristone tablets effectively promotes uterine contraction, softens and discharges intrauterine residue and contributes to uterine volume restoration in the patients after uterine curettage of incomplete abortion. The therapeutic effect of this combined therapy is better than simple oral administration of mifepristone tablets.
目的：比较电针八髎穴联合口服米非司酮片与单独口服米非司酮片治疗不全流产清宫术后宫内组织物残留的临床疗效及对宫腔容积复旧的影响。方法：将58例不全流产清宫术后患者随机分为电针组和西药组，各29例。西药组口服米非司酮片治疗，每次2片，每天1次；电针组在西药组基础上予以电针八髎穴（上髎、次髎、中髎、下髎），疏密波，每天1次，每次50 min，两组均治疗3 d为一疗程，1个疗程后休息1 d，共治疗2个疗程。记录两组患者治疗前后宫内组织物残留面积及彩色多普勒血流成像（CDFI）血流信号阳性率；记录两组患者治疗后阴道出血天数、二次手术率，通过三维超声重建测算两组患者月经复潮后宫腔内膜容积，并评定临床疗效。结果：治疗后，两组患者宫内组织物残留面积较治疗前减小、CDFI血流信号阳性率均较治疗前下降（P<0.05）；电针组宫内组织物残留面积小于西药组、CDFI血流信号阳性率低于西药组（P<0.05）。治疗后，电针组患者阴道出血天数短于西药组、二次手术率低于西药组（P<0.05），月经复潮后宫腔内膜容积大于西药组（P<0.05）。电针组总有效率为55.2%（16/29），高于西药组的37.9%（11/29，P<0.05）。结论：电针八髎穴联合口服米非司酮片可有效促进不全流产清宫术后患者子宫收缩，软化并排出宫内残留组织物，有利于宫腔容积复旧，疗效优于单独口服米非司酮片。.