子宫瘢痕部位妊娠的诊断及治疗

目的探讨子宫瘢痕部位妊娠的临床特点、诊断和治疗方法,为子宫瘢痕部位妊娠的治疗提供依据。方法选取剖宫产子宫瘢痕部位妊娠患者17例,分析探讨患者首发症状、诊断过程、辅助检查、治疗方法、经过及结局等。结果所有患者均有停经史,其中因阴道流血伴或不伴有下腹痛6例,6例患者因要求流产或常规检查B超检查发现为瘢痕部位妊娠,4例因人流或药流不全致阴道持续或大量流血而入院行介入治疗后再次清宫,有1例初始诊断稽留流产,因胚胎排出后阴道流血多无法控制而考虑为瘢痕部位妊娠,血β-HCG不同水平增高;17例患者均经盆腔彩超检查,其中12例开始治疗前即确诊为剖宫产子宫瘢痕部位妊娠,5例初始误诊,行人流,药流,钳刮术,因术后出血再次就诊时B超提示子宫前壁下段异常回声而确诊。17例患者均采用介入治疗;其中11例进行介入治疗后清宫治疗,4例行介入治疗后行子宫瘢痕病灶切除术,2例因B超提示孕囊边缘位于瘢痕部位,家属要求先行药物流产,后因药流后阴道流血多而行介入加B超监测下清宫术。结论子宫瘢痕部位妊娠通过超声检查可提供重要的诊断依据,确诊后采用子宫动脉介入栓塞术,24 h后行清宫术或子宫瘢痕部位切除而达到清除病灶目的,是一种比较安全、有效的治疗方法,值得临床推广应用。

Objective To explore the pathogenesis of pregnancy cesarean uterine scar parts, diagnosis,treatment methods and preventive measures,looking for the best for clinical prevention and treatment plan. Methods 17 patients with Cesarean Scar Pregnancy from June 2012 to February 2014 in our hospital were to be studied. A retrospective analysis of patients with initial symptoms discussed,diagnostic procedures,laboratory examinations,treatment,and outcome after and so on. Results All patients had a history of menopause,including six cases of vaginal bleeding with or without abdominal pain,6 patients due to miscarriage or required routine inspection B ultrasound examination revealed scar pregnancy, four cases of incomplete abortion or drug-induced vaginal continuous flow or heavy bleeding while hospitalized after intervention Qing line again, there is one case of an initial diagnosis of missed abortion,embryonic discharged because of vaginal bleeding after more than uncontrollable and consider scar pregnancy, serum β-HCG increased at different levels;17 patients were confirmed by pelvic ultrasound checks,including 12 cases diagnosed before starting treatment that caesarean section scar pregnancy, 5 cases of initial misdiagnosis, pedestrian flow,the drug flow, curretage,B-Tip anterior lower segment uterine bleeding due to abnormal echo and visit again confirmed. 17 cases of patients were treated with interventional therapy; curettage treatment of 11 patients after the intervention,4 patients underwent interventional treatment of uterine scar excision surgery, two cases because B-Tip gestational sac edge of the scar, the family requested advance medical abortion,later,becanse of vaginal bleeding after drug intervention plus multi underwent B-monitored curettage. Conclusion Treatment of uterine scar pregnancy can provide an important basis for the diagnosis by ultrasonography after diagnosis using uterine artery embolization,24 underwent curettage or hysterectomy scar removal to achieve the removal of the lesion site of the purpose,is a relatively safe and effective is worthy of recommendation.