剖宫产切口疤痕妊娠5例诊治体会

Experience of diagnosis and treatment of cesarean scar pregnancy in 5 cases

目的探讨子宫疤痕妊娠的诊断及治疗方法。方法回顾性分析2010年1月至2013年7月间佛山市三水区人民医院收治的5例剖宫产切口疤痕妊娠患者的临床诊治经过。结果在5例患者中,1例误诊行药物流产,因大出血行清宫术,术时阴道仍大出血行宫颈注射垂体后叶素及宫腔水囊压迫,再急诊行介入治疗,术中出血量2 000mL;1例行药物流产后阴道出血多,急诊行清宫术,清宫术后患者阴道出血减少,1周后停止,但血人绒毛膜促性腺激素(hCG)下降后有上升,再次入院行药物保守治疗治愈,术中出血量300mL;1例在子宫动脉栓塞后行经阴道子宫疤痕妊娠物切除术及子宫修补术,术中出血量20mL;1例在手术室直接行刮宫术,术后阴道出血多,予加强宫缩后阴道出血减少,术中出血量500mL;1例在拟行经阴道子宫疤痕妊娠切除术,术中因膀胱子宫腹膜返折粘连失败而改开腹手术,术中出血量40mL。结论应根据B超、血hCG值等综合考虑诊断子宫疤痕妊娠,明确诊断后应制定有效的个体治疗方案,垂体后叶素及宫腔水囊压迫在清宫术大出血时可减少阴道出血量。

Objective To explore the diagnosis and treatment of uterine scar pregnancy. Methods A retrospective analysis was conducted on the clinical treatment of 5 cases of cesarean scar pregnancy admitted in Sanshui District People＇ s Hospital during the period of January 2010 to July 2013. Results One case accepted medical abortion by misdiagnosis, and curettage was performed because of bleeding. Intraoperative vaginal bleeding was treated with injection of vasopressin and uterine cysts oppression, and then emergency interventional therapy was taken. The vaginal bleeding volume during the surgery was 2 000mL. Vaginal bleeding was much after medical abortion in one case. It accepted emergency curettage and then vaginal bleeding decreased. Although one week later vaginal bleeding stopped, the level of hCG decreased at first but then increased. Conservative medical treatment was given to cure at second admission, and the intraoperative bleeding volume was 300mL. In one case uterine scar pregnancy thing suffered transvaginal hysterectomy and uterine repair because of uterine artery embolization, with intraoperative bleeding volume of 20mL. One case accepted curettage in operating room. Postoperative vaginal bleeding was much, and it decreased after strengthening contractions. The intraoperative bleeding volume was 500mL. One case accepted open surgery because of the failure on bladder uterus peritoneal adhesions with the original scheme of transvaginal hysterectomy. The intraoperative bleeding volume was 40mL. Conclusion B-ultrasonography and blood hCG should be considered in the diagnosis of uterine scar pregnancy. Effective individual treatment should be developed after clear diagnosis. Vasopressin and uterine cysts oppression can reduce the amount of vaginal bleeding during curettage.