介入技术在终止剖宫产后子宫下段疤痕早期妊娠的应用

Application of Intervention Technique for Termination of Lower Uterine Segment Pregnancy in the First Trimester after Caesarean Section

目的:探讨剖宫产后子宫下段疤痕早期妊娠的诊断和处理.方法:回顾分析1994年5月～2004年8月本院收治24例剖宫产后子宫下段疤痕妊娠合并胎盘绒毛植入的临床资料.结果:24例中,9例术前未明确诊断,流产术中大出血,并行子宫动脉栓塞,其中1例栓塞后要求切除子宫;15例术前明确诊断,先行子宫动脉栓塞,而后再行流产术,无一例大出血保留了子宫.结论:有剖宫产史的患者,再次妊娠时有发生子宫下段疤痕妊娠的危险,行流产术时可能出现难以控制的大出血,子宫动脉栓塞是首选的行之有效的治疗方法.

Objective： To explore the diagnosis methods and treatment for the lower uterine segment pregnancy in the first trimester after caesarean section. Method： 24 cases of lower uterine segment pregnancy with complication of placental accreta from May 1994 to Aug 2004 were retrospectively analysed. Results ： Nine cases of twenty - four patients were not diagnosed definitely before induced abortion, and they had heavy hemorrhage and received uterine artery embolization（UAE） when they received inducing abortion in the first trimester. One of nine patients asked hysterectomy after UAE. 15 cases of definite diag- nosis before inducing abortion that were performed UAE first and had induced abortion in the first trimester. None of them had heavy hemorrhage and had hysterectomy. Conclusion： Previous caesarean section is one risk factor causing lower uterine segment pregnancy. Heavy uterine hemorrhage occurs possibly when they are receiving induced abortion in the first trimester. UAE is one of the best conservation managements.