剖宫产后子宫瘢痕处妊娠临床诊治探讨

目的探讨剖宫产手术后子宫切口处瘢痕妊娠的诊断和治疗方法。方法回顾性分析2009年2月～2010年10月期间因剖宫产瘢痕妊娠在进行诊治的8例患者的临床资料,并进行追踪随访分析。结果 8例患者中7例表现为停经后阴道出血,量中,伴轻微腹痛,B超子宫瘢痕处妊娠,其中1例行子宫切除术,3例行开腹楔型切除术,1例外院以宫外孕失血性休克转入院,术中确诊并行子宫次全切除术,2例行甲氨蝶呤药物治疗B超监护下吸宫术保守治疗成功;另外1例无明显阴道出血及腹痛的症状,经B超检查发现,行宫腔镜下胚物切除术联合甲氨蝶呤宫颈注射,保守治疗成功。结论有剖宫产病史的患者再次妊娠时,很有可能发生子宫瘢痕处妊娠,常可发生危及生命的出血,应该尽早超声诊断,及时处理,可以用药物及微创手术进行保守治疗成功,降低子宫切除率。

Objective To investigate the diagnosis and therapy of cesarean cicatrix pregnancy. Methods Retrospective analysis of February 2009 - October 2010 by cesarean section scar during pregnancy in our hospital for diagnosis and treatment of 8 patients with clinical data. Results In 8 patinents.7 cases showed postmenopausal vaginal bleeding, weight, with slight abdominal pain, B-mode ultrasonography of uterine scar pregnancy. 1 case of hysterectomy, 3 routine open wedge resection, 1 case with ectopic pregnancy hemorrhagic shoch to admission to hospital, diagnosed intraoperatively parallel subtotal hysterectomy, 2 routine methotrexate drug therapy under B ultrasound monitoring uterine aspiration successfully treated conservatively; another patient showed no vaginal bleeding and abdominal pain symptoms. By B ultrasound examination revealed a palace. Endoscopic embryo material excision combined with methotrexate in cervical injection. Successful conservative treatment. Conclusion The cesarean cicatrix pregnancy must be diagnosed and termination of pregnancy in earlier period, it is possible to use medicine and minimal operation can cure the disease and reduce the rate of hysterectomy.