子宫下段剖宫产瘢痕妊娠的早期诊断的临床研究

Early diagnosis of scar pregnancy after lower uterine segment cesarean section

目的对子宫下段剖宫产瘢痕妊娠的早期诊断进行临床研究。方法选择2008年1月～2009年5月在某医院妇产科收治的子宫下段剖宫产瘢痕妊娠患者30例,年龄25～34岁,平均年龄27.3岁。诊断方法为彩色多普勒超声检查、妊娠试验、核磁共振成像(MRI)。结果 3例误诊为先兆流产,4例误诊为稽留流产,2例漏诊,5例行清宫术术中出血大于200 ml行床边B超诊断为子宫下段瘢痕妊娠,行急诊双侧子宫动脉栓塞术(UAE);4例行终孕引产清宫术,术中出血大于200 ml行床边B超诊断为子宫下段瘢痕妊娠,行急诊双侧子宫动脉栓塞术;17例诊断为子宫下段瘢痕妊娠,其中1例行子宫下段瘢痕妊娠病灶清除术;13例行UAE和(或)MTX、米非司酮化疗后在B超引导下或宫腔镜直视下行清宫术,术中出血少于20ml。结论在各种早期诊断方法中,经阴道超声检查是诊断子宫下段瘢痕妊娠最主要的手段,争取早期诊断.避免误诊、漏诊.避免盲目宫腔操作。

Objective To research the early diagnosis of scar pregnancy after the lower uterine segment cesarean section. Methods From January 2008 to May 2009 30 patients with scar pregnancy after obstetric uterine lower segment cesarean admitted in a hospital, aged 25 to 34 years, mean age 27. 3 years. Diagnostic methods included the color Doppler ultrasound, pregnancy test, magnetic resonance imaging （MRI）. Results 3 cases were misdiagnosed as threatened abortion, 4 cases were misdiagnosed as missed abortion, missed 2 cases, blood loss of 5 cases was greater than 200 ml and was diagnosed as scar pregnancy after the lower uterine segment, underwent emergency bilateral uterine artery embolization （UAE） ; 4 routine induction of labor in pregnant and curettage, blood loss greater than 200 ml line bedside diagnosis of B - segment uterine scar pregnancy, underwent emergency bilateral uterine artery embolization; 17 cases diagnosed as uterine segment scar pregnancy, in which a lower uterine segment scar pregnancy routine debridement surgery; 13 cases UAE and / or MTX, mifepristone after chemotherapy in B - guided curettage or hysteroscopy look down, blood loss less than 20 ml. Conclusion There are a variety of methods for diagnosis of scar pregnancy after the lower uterine segment, and the most important means for early diagnosis and avoiding misdiagnosis is transvaginal sonography.