4例持续性剖宫产瘢痕妊娠并发症分析

Complication analysis of 4 patients with persistent cesarean scar pregnancy

目的:探讨持续性剖宫产瘢痕妊娠(PCSP)并发症的临床特点、诊断和治疗。方法:对4例出现PCSP并发症的患者临床资料进行回顾性分析。结果:4例PCSP患者中3例出现子宫动静脉瘘(UAVF),1例出现大出血。患者均有CSP术后阴道出血表现,1例出血约1400ml。超声/磁共振(MRI)提示子宫前壁下段非均质包块,3例提示UAVF可能。1例UAVF患者仅行双侧子宫动脉栓塞术,但术后包块持续存在;2例UAVF患者行宫腔镜宫内异物(瘢痕妊娠)取出术+宫腔组织吸引术+宫腔球囊放置术,术后恢复好;大出血患者双侧子宫动脉栓塞术后行腹腔镜下子宫病损切除+子宫修补+宫腔镜下诊刮术,术后恢复好。结论:超声、MRI、子宫动脉造影可为UAVF的诊断提供主要依据;UAVF和大出血患者根据出血情况酌情选择子宫动脉栓塞术,宫腔镜或腹腔镜手术均为安全有效的治疗方法。

Objective:To discuss the clinical characteristics,diagnosis,and treatment of the complications of patients with persistent cesarean scar pregnancy(PCSP).Methods:The clinical data of 4 patients with PCSP and complications were analyzed retrospectively.Results:3 patients had developed uterine arteriovenous fistula(UAVF),and 1 patient had hemorrhoea.All the patients had vaginal bleeding after CSP surgery,with 1 patient bleeding approximately 1400ml.The results of ultrasound/magnetic resonance imaging(MRI)showed these patients had the heterogeneous mass in the inferior anterior wall of the uterus,and indicating that there were 3 cases with the possibility of UAVF.1 patient with UAVF only had undergone the bilateral uterine artery embolization,but the mass of this patient had persisted after the surgery.2 patients with UAVF had undergone hysteroscopic removal of intrauterine foreign bodies(scar pregnancy),uterine tissue aspiration,and uterine balloon placement,and with the better recovery after surgery.The patient with hemorrhoea had undergone bilateral uterine artery embolization,laparoscopic hysterectomy,uterine repair,and hysteroscopic curettage,and also with the better recovery after surgery.Conclusion:The examinations of ultrasound,MRI,and uterine arteriography of the patients can provide the main basis for diagnosing their UAVF.The patients with UAVF and hemorrhoea should choose uterine artery embolization according to the bleeding situation.Both hysteroscopy and laparoscopic surgeries are safe and effective.