剖宫产术后切口妊娠临床分析

Clinical analysis of ectopic pregnancy in the cesarean scar for 22 cases

目的探讨子宫下段剖宫产术后切口妊娠的临床诊断和治疗。方法回顾性分析了2002年1月至2006年12月中南大学湘雅二医院收治的子宫下段剖宫产术后切口妊娠,共22例患者的临床资料,包括一般情况、临床表现、辅助检查等。结果采用药物治疗11例,药物治疗加手术治疗5例,双侧子宫动脉栓塞介入治疗2例,手术治疗4例。22例中治疗成功18例,失败4例。结论有剖宫产史的流产病例,应先行超声检查,血尿β-HCG的检测,根据病情选择药物治疗、介入治疗、宫腹腔镜治疗或子宫局部病灶切除加子宫修补术等治疗措施。

Objective To investigate the early diagnosis and treatment of ectopic pregnancy in the cesarean scar. Methods Twenty-two patients＇clinical datum who were treated in the second hospital of Xiangya with cesarean scar ectopic pregnancy were analyzed retrospectively, including medical history ,clinical manifestation, auxiliary examination and so on. Results Eleven cases were treated with medication,5 cases were treated with medication and operation,2 cases cases were treated with bilateral uterine atheroembolism interventional therapy,4 cases were treated with operation. In all patients, 18 cases were successful ,4 ca- ses were failure. Conclusion The patients who have history of previous caesarean section should take ultrasound and β - HCG test when they are conceived. Cesarean scar pregnancy can be effectively treated by medical treatment, uterine artery emboliza- tion, therapeutic laparoscopy and hysteroscopy, excision of the gestational mass via laparotomy combined with repair of the uterus.