剖宫产术后再次妊娠人工流产临床分析

Clinical Analysis of Abortion in Patients with Secondary Pregnancy after Cesarean Section

目的探讨剖宫产术后再次妊娠行人工流产的危险性及临床治疗方法。方法对剖宫产术后再次妊娠5000例患者在静脉麻醉下行负压吸引术,其中有1740例在腔内B超引导下行人工流产术。结果人工流产完成较满意,无1例发生子宫穿孔及漏吸,术中出血较多有50例,26例出现大出血,为子宫疤痕处妊娠,其中9例经保守治疗无效,行子宫切除术,17例经子宫动脉栓塞及对症处理后行化疗杀胚等治疗后痊愈出院。结论剖宫产术后因子宫的变化增加了人流手术的操作难度,更易造成术中及术后并发症。其中剖宫产术后子宫疤痕处妊娠(CSP)是罕见而危险的妊娠类型,我院其发生率约为0.52%,应早期诊断,避免盲目吸宫,也可以在B超下及时发现及诊断CSP,先给予子宫动脉栓塞治疗,再吸宫,避免宫腔操作发生致命性大出血。

Objective To explore the risk and clinical treatment of induced abortion in patients with secondary pregnancy after cesarean section. Methods 5 000 patients with secondary pregnancy after cesarean section were taken vacuum aspiration under intravenous anesthesia,among them 1 740 patients were taken the abortion under B ultrasound-guided in the cavity. Results The abortion was satisfactorily completed,there were no uterine perforation and suction drain,there were 50 cases of more blood loss,26 cases of bleeding occurred,which was cesarean scar pregnancy,among them 9 cases were taken hysterectomy after failure of conservative treatment,17 cases were discharged after the treatments of uterine artery embolization and chemotherapy to kill embryos. Conclusion Changes in the uterus after cesarean section increase the difficulty of abortion operation,it is more likely to result in intraoperative and postoperative complications. Cesarean scar pregnancy（CSP） is a rare and dangerous type of pregnancy,the incidence in our hospital is approximately 0.52%,it should be early diagnosed in order to aviod the blind suction palace,it also shoule be timely found and diagnosed CSP in B ultrasound,first the uterine artery embolization is given,and then suction palace to avoid the occurrence of fatal bleeding in uterine operation.