剖宫产术后子宫疤痕处妊娠的诊断及治疗效果分析

Analysis of diagnosis and surgical treatment of patients with cesarean section pregnancy

目的探讨剖宫产术后疤痕处妊娠的早期诊断及治疗效果。方法选择2005年1月至2010年10月期间收治的剖宫产疤痕处妊娠病例共34例,分析其发病机制、治疗方式及治疗效果。结果 8例直接行超声引导下清宫术,7例行米非司酮联合氨甲喋呤化疗后超声引导下清宫术,7例直接行腹式子宫切开清除胚胎术加子宫疤痕切除缝合术,10例化疗后行腹式子宫切开清除胚胎术加子宫疤痕切除缝合术,1例行腹腔镜下子宫切开清除胚胎术加子宫疤痕切除缝合术,1例行腹腔镜监护下宫腔镜下子宫疤痕处胚物切除术。其中2例子宫切除,34例患者均治愈出院。结论疤痕子宫妊娠应及早行超声检查,一旦发现,及早采用个体化治疗,避免切除子宫。

Objective To investigate the early diagnosis and the reasonable treatment measures for the patients with cesarean section pregnancy.Methods Retrospectivly analyze the clinical data of 34 patients with cesarean section pregnancy between January 2005 to October 2010 in Gynecologic of the third affiliated hospital of Zhengzhou University.Analyze the pathogenesis,the treatment measures and the effects.Results 8 of the 34 cases were subjected to the abortion under B-ultrasound,7 cases were subjected to abortion after successfully conservatively treated by Mifepristone and Methotrexate,7 cases made the focal cleaning and repair of the uterus,10 cases made the focal cleaning and repair of the uterus after being treated by Mifepristone and Methotrexate,1 case made the focal cleaning and repair of the uterus of laparoscope surgery,1 case made the focal cleaning and repair of the uterus of Hysteroscopic surgery.2 of 34 cases subjected to hysterectomy,all patients were cured.Conclusions B-ultrasound should be used as early as possible to confirm the place where the embro implanted,when confirm,use reasonable treatment measures avoiding hysterectomy.