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剖宫产术后子宫瘢痕妊娠18例临床诊治分析

Clinical Diagnosis and Treatment of 18 Cases of Uterine Scar Pregnancy after Cesarean Section
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摘要 目的 总结剖宫产术后子宫瘢痕妊娠临床诊治经验,为剖宫产术后子宫瘢痕妊娠临床诊治决策的制定提供新思路、新方法。方法 纳入我院妇产科病房2016年1月至2021年12月具有完整资料剖宫产术后子宫瘢痕妊娠18例住院患者,回顾性分析这18例临床诊断及治疗数据。结果 12例剖宫产术后子宫瘢痕妊娠分型为Ⅰ型,均行子宫动脉栓塞+清宫术,4例剖宫产术后子宫瘢痕妊娠分型为Ⅱ型,其中3例行子宫动脉栓塞+腹腔镜监测下清宫术,其中1例行阴式瘢痕妊娠清除+子宫瘢痕修补术,2例剖宫产术后子宫瘢痕妊娠分型为Ⅲ型,均行子宫动脉栓塞术+腹腔镜监测下妊娠物清除+子宫瘢痕憩室切除+子宫修补术,其中仅1例Ⅱ型患者因瘢痕妊娠局部残留而行超声介入下局部注射硬化剂后再次行清宫术,全部18例最终均顺利达到临床治愈,未出现术中、术后大出血并发症。结论 剖宫产术后子宫瘢痕妊娠若得到及时、准确地诊断,在子宫动脉栓塞术、腹腔镜辅助手术、超声介入治疗后清宫术、腹腔镜或阴式子宫瘢痕憩室切除修补术等技术方法综合化、个体化治疗下,能够安全、及时地得到治愈。 Objective To summarize the clinical diagnosis and treatment experience of uterine scar pregnancy after cesarean section,and to provide new ideas and methods for the formulation of clinical diagnosis and treatment decisions of uterine scar pregnancy after cesarean section.Methods A total of 18 cases of uterine scarring after cesarean section were collected from January 2016 to December 2021 in the same medical group of the same medical ward of our hospital,and the clinical diagnosis process,detailed treatment decision-making process and treatment implementation of these 18 cases were retrospectively studied.Results Twelve cases of uterine scar pregnancy after cesarean section were classified as type Ⅰ,all of which underwent uterine artery embolization + uterine evacuation,4 cases of uterine scar pregnancy after cesarean section were classified as type Ⅱ,of which 3 cases underwent uterine artery embolization + laparoscopic monitoring of uterine evacuation,of which 1 case underwent vaginal scar pregnancy removal + uterine scar repair,2 cases of uterine scar pregnancy after cesarean section were classified as type Ⅲ,all underwent uterine artery embolization + laparoscopic monitoring of pregnancy removal + uterine scar diverticulectomy + uterine repair Among them,only one type Ⅱcase underwent local injection of sclerotherapy under ultrasound intervention and then underwent uterine evacuation due to local residual pregnancy scar,and all 18 cases finally achieved clinical cure,and there were no complications of intraoperative and postoperative hemorrhage.Conclusion If the pregnancy with uterine scar after cesarean section is diagnosed in a timely and accurate manner,it can be safely and timely cured under the comprehensive and individualized treatment of technical means such as uterine artery embolization,laparoscopic assisted surgery,uterine evacuation after ultrasound intervention,laparoscopic or vaginal uterine scar diverticulectomy and repair.
作者 施小龙 杨云玲 陈硕 夏萍 SHI Xiaoong;YANG Yuning;CHEN Shuo;XIA Ping(Department of Obstetrics and Gynecology,Jinshan Hospital,Fujian Clinical College,Fujian Medical University,Fuzhou 350028,)
出处 《中国医药指南》 2023年第22期76-78,共3页 Guide of China Medicine
基金 福建省自然科学基金(编号:2021J01361)。
关键词 子宫瘢痕妊娠 剖宫产 治疗方法 Uterine scar pregnancy Cesarean Treatment
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