人流术前临床漏诊的剖宫产瘢痕部位妊娠患者临床分析

Clinical analysis of induced abortion bleeding of missed diagnosis of cesarean section scar pregnancy

目的:分析人流术前临床漏诊的剖宫产瘢痕部位妊娠(CSP)患者术中、术后出血的急诊治疗方法和预防措施。方法:选取2013年1月-2016年6月收治的人流术前临床漏诊的CSP患者8例,回顾性分析人流术中、术后出血的诊断和治疗方法。结果:8例CSP患者中,6例在人流术中发生出血,其中2例宫腔吸引1次即发生阴道大量出血;1例瘢痕部位妊娠病灶切除+修复术;1例行宫腔水囊压迫后宫颈口仍有持续鲜红色血液流出,行子宫动脉栓塞术止血;另4例人流结束后宫颈口有持续鲜红色血液流出,行宫腔水囊压迫后即止血。1例术后阴道流血持续未净,彩超复查提示CSP,予MTX治疗后出院随诊观察;1例术后29 d突然出现阴道大出血,彩超检查提示CSP,急诊清宫后行宫腔水囊压迫止血。结论:随着剖宫产率逐年升高及二胎政策的开放,CSP发病率亦逐年上升。CSP发病率与剖宫产率密切相关,降低剖宫产率是CSP的主要预防方法。早期诊断CSP和有效干预是改善预后的最佳方法。CSP的治疗应根据患者临床分型、彩超、β-HCG结果等实行个体化治疗,对于人流时大出血的漏诊患者,可采用宫腔水囊压迫止血,宫腔水囊压迫操作简单、迅速,可立即减少局部出血,并为后续介入和手术治疗赢得时间。

Objective:To analyze the diagnosis,emergency treatment and preventive measures of intraoperative and postoperative hemorrhage of clinically missed diagnosis of cesarean scar site pregnancy(CSP)before induced abortion.Methods:From January 2013 to June 2016,8 patients of missed diagnosis of CSP were enrolled,the diagnosis and treatment methods of intraoperative and postoperative bleeding of induced abortion were retrospective analyzed,Results:All of 8 cases of CSP,for 6 cases,bleeding occurred during induced abortion,in 2 cases,a large amount of vaginal bleeding occurred immediately when the uterine cavity was attracted once,1 case underwent resection+repair of pregnancy lesions at the scar site,in 1 case,the uterine cavity water sac pressed the harem neck mouth still had the continuous bright red blood outflow,performed the uterine artery embolization to stop the bleeding.In the other 4 cases,there was a continuous bright red blood flow at the cervical,stopped bleeding after intrauterine water-filled balloon oppression.1 case had continued unclean vaginal bleeding after operation,color doppler reexamination suggested CSP,which was given follow-up observation after MTX treatment.Sudden vaginal bleeding occurred in 1 case in 29 days after surgery,color doppler examination prompted CSP,urgent sac compression was used to stop bleeding after emergency treatment.Conclusion:With the increasing rate of cesarean section and the opening of the second child policy,the incidence of CSP is increasing year by year.The incidence of CSP is closely related to the rate of cesarean section.Reducing the rate of cesarean section is the main preventive method of CSP.Early diagnosis of CSP and effective intervention is the best way to improve prognosis.The treatment of CSP should be based on the clinical classification of patients,color ultrasound,β-HCG results and other individualized treatment,for the missed diagnosis patients with massive bleeding during induced abortion,the operation of uterine cavity water sac compression is simple and rapid,which can immediately reduce local bleeding and win time for subsequent intervention and surgical treatment.