剖宫产瘢痕妊娠10例诊治方法探讨

Discussion on diagnosis and treatment of 10 cases with scar pregnancy after cesarean section

目的:探讨剖宫产瘢痕妊娠的诊治方法。方法:对2004年～2008年间在石家庄市第四医院收治的10例剖宫产瘢痕妊娠病例进行回顾性分析。结果:剖宫产瘢痕妊娠10例,7例由阴道彩色超声(TV-US)明确诊断后在子宫动脉栓塞术后3天由B超引导行吸宫术,1例外院误诊早孕行人流术后阴道间断出血,B超提示子宫下段强回声团块,予肌注MTX保守治疗成功,1例TV-US提示孕囊距子宫峡部浆膜层0.3 cm,行宫腔镜下人流术,1例B超提示子宫瘢痕处包块突向盆腔,在全麻下宫腹腔镜联合行剖宫产瘢痕妊娠病灶清除术。结论:阴道彩色超声是诊断剖宫产瘢痕妊娠的主要手段。子宫动脉栓塞辅助吸宫术是安全有效的治疗方法,宫腹腔镜的选择可以根据妊娠囊的种植部位而定,通过宫腔镜检查定位,突向宫腔的孕囊行宫腔镜手术清除;反之,对异位妊娠囊植入深者适合采用腹腔镜手术处理。

Objective：To explore the diagnosis and treatment of the cases with scar pregnancy after cesarean section. Methods：Ten cases with scar pregnancy after cesarean section who were treated in the hospital from 2004 to 2008 were analyzed retrospectively. Results：Among 10 cases with scar pregnancy after cesarean section,7 cases were diagnosed definitely by transvaginal color ultrasonography（TV-US）,then they underwent ultrasound-guided suction curettage at three days after uterine artery embolization;one case was misdiagnosed as early pregnancy,then the case was found with intermittent vaginal bleeding after artificial abortion,ultrasound displayed mass with strong echo in the lower uterine segment,then the case was treated with conservative therapy of intramuscular injection of MTX,the therapy was successful;one case was informed that the distance between gestational sac and serosa layer of isthmus of uterus was 0.3 cm by ultrasonography,then hysteroscopic artificial abortion was conducted;one case was informed that the mass in uterine scar protruded into pelvic cavity,focal cleaning under hysteroscope and laparoscope was conducted with general anesthesia. Conclusion：TV-US is the main method to diagnose scar pregnancy after cesarean section;uterine artery embolization combined with suction curettage is a safe and effective therapy,the choice of hysteroscope and laparoscope depends on the locations of implantation of gestational sac,the gestational sac which protrudes into uterine cavity can be cleaned by hysteroscopy;conversely,the cases with gestational sac protruding into uterine cavity deeply can be treated with laparoscopy.