剖宫产后切口妊娠的临床诊治分析

A Clinical Diagnosis and Treatment of Ectopic Pregnancy in the Cesarean Scar

目的:研究剖宫产后子宫切口妊娠的临床表现及治疗方法等特征,为临床医生早期诊断、早期处理本病提供依据。方法:对25例患者的病史、临床表现、诊断方法以及治疗方法进行回顾性分析。结果:25例患者中有23例经阴道超声检查或彩色多普勒超声检查确诊;本病初诊误诊19例,误诊率76%,25例患者中保守治疗22例,21例痊愈,占95.45%;2例治疗失败而行全子宫切除术。结论:有剖宫产史的妇女因停经就诊时,要常规行阴道超声检查,对阴道超声怀疑切口妊娠的病例,有必要行彩色多普勒超声检查;彩色多普勒超声检查可作为诊断切口妊娠的主要方法;甲氨蝶呤加清宫术可作为治疗切口妊娠的主要方法,可有效地避免子宫切除。

Objective：To study the clinical presentations and treatment of ectopic pregnancy in the cesarean scar and to provide a guideline for early diagnosis and treatments of this disease, Methods：We retrospectively analyzed the medical history, clinical manifestation,diagnoses and treatments in 25 patients with ectopic pregnancy in the cesarean scar, Results：23 of total 25 cases got diagnosed by TVS, The error rate of first diagnosis was 76% （ 19/23）, Diagnosis mainly depended on CDFI and TVS, There were 22 cases got conservative therapy with MTX combined curettage and 21 cured finally, Only two cases underwent total hysterectomy as of failed medicine therapy, Conclusions：The patients who have history of previous CS should take ultrasound test regularly when they are conceived, CDFI is recommended to those suspected with pregnancy in the cesarean scar as a main and accurate method for diagnosis for this disease, Management of MTX combined curettage is an important treatment to avoid effectively hysterectomy.