10年子宫腔下部妊娠病例的回顾性分析

Retrospective Analysis about the Pregnancy in Lower Part of Uterine in Past Ten Years

目的探讨子宫腔下部妊娠的病因、诊断、治疗方法及其疗效。方法对26例子宫腔下部妊娠（孕6～27周）病例资料进行回顾性分析。结果子宫峡部妊娠（孕6～14周）病例18例：11例宫颈局部注射氨甲喋呤（MTX）治疗有效；3例米索前列醇引产术成功；4例行清宫术，其中1例全子宫切除术。胎盘低置状态（孕11～22周）8例：5例行引产和清宫术；3例行剖宫取胎术，其中2例子宫全切术。结论对于确定子宫腔下部妊娠要求人工流产的病例，根据孕周、妊娠着床部位、阴道出血量、生命体征、超声下宫壁血流状态和血HCG测定值，选择MTX局部注射、清宫术、剖宫取胎术，操作前应做好急救和开腹手术的准备，有条件的医院可予以子宫动脉栓塞止血治疗，对于各种止血措施无效者，应以抢救孕妇生命为关键，行子宫切除术。

Objective To investigate the etiology, diagnosis, treatment on the pregnancy in lower part of uterus. Methods Twenty-six women of the pregnancy in lower part of uterus were treated in the last ten years, and the cases were analyzed. Results In this study, 18 cases about the lower uterine segment pregnancy. Of these cases, 11 patients were treated with methotrexate and Chinese medicine, 3 patients with medicine induced abortion, 4 patients adopted dilatation and curettage, one of the eleven patients had hysterectomy. There were 8 cases about placenta increta. Of these eases, 5 patients adopted abortion and curettage, 3 patients had caesarean section, 2 of the three patients had hysterectomy for active bleeding. Conclusion Previous curettage and caesarean section are the risk factors of the pregnancy in lower part of uterus. Its treatment methods depend on the pregnant weeks, the part of placenta implantation, the blood loss, the blood signal under ultrasonic examination and the HCG value. We must have a good preparation for the emergency, and have hysterectomy necessarily.