剖宫产术后子宫疤痕部位妊娠的诊治探讨

Clinical analysis of the cesarean scar pregnancy

目的通过对本院诊治的疤痕子宫妊娠的分析,探讨其早期诊断和最佳治疗方法,减少子宫切除率。方法回顾分析近3年来4例在本院剖宫产术后子宫疤痕妊娠患者的诊治过程。结果3例首诊误诊,导致3例均在人流术时阴道大出血,2例子宫破裂失血性休克,急诊行子宫切开取妊娠物疤痕切除修补术,1例子宫全切术,1例早期诊断、未清宫、药物治疗成功。结论子宫疤痕妊娠误诊率高,对有剖宫产史的患者,人流前应仔细B超检查,作出早期诊断,争取保守治疗,减少手术创伤。对急性出血失血性休克的患者,子宫峡部切开清除妊娠物加疤痕切除修补是迅速止血,保全子宫的好方法。

Aim To investigate the therapeutic method for cesarean scar pregnancy,thus arousing clinical attentions to increasing early diagnosis rate and reducing the hysterectomy.Methods The management process of 4 cases of the cesarean scar pregnancy was retrospectively analyzed jinhua central hospital in the past three years.Results There were 3 cases misdiagnosed at first.Thus they all had vagina massive hemorrhages during the artificial abortions.The first and the second cases received clearance of the uterus cicatricial cyesis via the section on the isthmic portion of uterus.One case received hysterectomy.One case was successful with MTX.Conclusion To the multipara ever had cesarean delivery,B-ultrasound detect should be concluded into the routine check-up,and an early diagnosis should be made.The general artificial abortion and operation should be avoided.Clearance of the uterus cicatrcical cyesis via the section on the isthmic portion of uterus is a good way to hemostasia and saving the uterus,when there is massine hemorrhages.