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Emergency internal iliac artery temporary occlusion after massive hemorrhage during surgery of cesarean scar pregnancy:A case report 被引量:1
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作者 Ji-Ping Xie Lin-Lin Chen +3 位作者 Wen Lv Wu Li Hui Fang Guang Zhu 《World Journal of Clinical Cases》 SCIE 2023年第17期4065-4071,共7页
BACKGROUND Cesarean scar pregnancy(CSP)is rare but may result in uterine rupture during pregnancy or massive hemorrhage during abortion procedures.Awareness of this condition is increasing,and most patients with CSP a... BACKGROUND Cesarean scar pregnancy(CSP)is rare but may result in uterine rupture during pregnancy or massive hemorrhage during abortion procedures.Awareness of this condition is increasing,and most patients with CSP are now diagnosed early and can be managed safely.However,some atypical patients are misdiagnosed,and their surgical risks are underestimated,increasing the risk of fatal hemorrhage.CASE SUMMARY A 27-year-old Asian woman visited our institution because of abnormal pregnancy,and she was diagnosed with a hydatidiform mole through transvaginal ultrasound(TVS).Under hysteroscopy,a large amount of placental tissue was found in the scar of the lower uterine segment,and a sudden massive hemorrhage occurred during the removal process.The bilateral internal iliac arteries were temporarily blocked under laparoscopy,and scar resection and repair were rapidly performed.She was discharged in good condition 5 d after the operation.CONCLUSION Although TVS is widely used in the diagnosis of CSP,delays in the diagnosis of atypical CSP remain.Surgical treatment following internal iliac artery temporary occlusion may be an appropriate management method for unanticipated massive hemorrhage during CSP surgery. 展开更多
关键词 Internal iliac artery temporary occlusion cesarean scar pregnancy Uterine artery embolization MISDIAGNOSIS HYSTEROSCOPY LAPAROSCOPY Case report
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Experience in Surgical Coordination of Type III Cesarean Scar Pregnancy Removal with Combined Assistance of Hysteroscopy and Laparoscopy
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作者 Fang Zhou Jinfeng Tan +2 位作者 Ying Li Qinfang Huang Yanfen Teng 《Journal of Clinical and Nursing Research》 2023年第3期13-18,共6页
Objective:This paper aims to summarize the operative nursing coordination essentials of type III cesareans car pregnancy removal.Methods:Six patients were recruited for this study,and the patient’s condition was full... Objective:This paper aims to summarize the operative nursing coordination essentials of type III cesareans car pregnancy removal.Methods:Six patients were recruited for this study,and the patient’s condition was fully evaluated before the operation.In addition,the personnel,environment,and materials were well prepared before the operation,and the preparation of special intraoperative instruments and equipment was perfected.Results:The operation is successfully performed in all six patients.Each surgery lasted 70 to 120 minutes with an average duration of 90 minutes.Postoperative blood loss was about 100-500 ml.Postoperative recovery was good without complications in all the patients.Conclusion:In summary,laparoscopic removal of gestational tissue from type III cesareans car pregnancy in conjunction with hysteroscopy ensures compete removal of gestational tissue,while avoiding damaging the surrounding organs and tissues,thus greatly avoiding common complications which usually occur during the surgery.Effective surgical coordination is helpful to further improve the success rate of the operation. 展开更多
关键词 cesarean scar pregnancy(csp) Hysteroscopic assistance Surgical coordination Gestational tissue
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DIAGNOSIS AND TREATMENT OF CESAREAN SCAR PREGNANCY 被引量:65
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作者 Lan-zhou Jiao Jun Zhao Xi-run Wan Xin-yan Liu Feng-zhi Feng Tong Ren Yang Xiang 《Chinese Medical Sciences Journal》 CAS CSCD 2008年第1期10-15,共6页
Objective To investigate the early diagnosis and treatment of cesarean scar pregnancy (CSP). Methods Clinical data of 28 patients with CSP in Peking Union Medical College Hospital from January 1994 to April 2007, i... Objective To investigate the early diagnosis and treatment of cesarean scar pregnancy (CSP). Methods Clinical data of 28 patients with CSP in Peking Union Medical College Hospital from January 1994 to April 2007, including age, interval from the last cesarean delivery to diagnosis, clinical presentation, location of the lesion, process of diagnosis and treatment, outcome, and follow-up, were retrospectively analyzed. Re, salts CSP constituted 1.05 % of all ectopic pregnancies, and the ratio of CSP to pregnancy was 1 : 1 221. The mean age of the group was 31.4 years. Twenty-six women had only one prior cesarean delivery. The interval from the last cesarean delivery to diagnosis ranged from 4 months to 15 years. The most common presenting symptoms of CSP were amenorrhoea and vaginal bleeding. Seventeen cases were misdiagnosed as early intrauterine pregnancies and 2 were misdiagnosed as gestational trophoblastic tumor. The other 9 were diagnosed definitely before treatment. The diagnosis was made based on cesarean delivery history, gynecologic examination, ultrasound, and magnetic resonance imaging (MRI). The treatment of CSP included systemic or local methotrexate administration, conservative surgery, and hysterectomy. The conservative treatment was successful in 24 cases. All of the 28 women were cured through individual therapies. Conclusions CSP is rare and usually misdiagnosed as other diseases. Ultrasound is valuable for diagnosing CSP, and MRI can be used as an adjunct to ultrasound scan. Early diagnosis offers the options of conservative treatment and greatly improves the outcome of patients. Individual therapy is strongly recommended. 展开更多
关键词 cesarean scar pregnancy MISDIAGNOSIS early diagnosis individual therapy
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Management of Cesarean Scar Pregnancy: A Case Series 被引量:9
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作者 Min-hui Guo Mei-fen Wang +3 位作者 Man-man Liu Feng Qi Fan Qu Jian-hong Zhou 《Chinese Medical Sciences Journal》 CAS CSCD 2015年第4期226-230,共5页
Objective To survey effective treatment strategies for cesarean scar pregnancy(CSP). Methods The clinical data of 78 patients diagnosed with CSP from January 2010 to December 2013 were reviewed. Results Among these pa... Objective To survey effective treatment strategies for cesarean scar pregnancy(CSP). Methods The clinical data of 78 patients diagnosed with CSP from January 2010 to December 2013 were reviewed. Results Among these patients, 17 patients were first treated at our hospital; of them, 2 were misdiagnosed. The other 61 patients were referred from other hospitals; of them, 21 were initially misdiagnosed. There were 9 patients who were treated with laparotomy, 50 patients with curettage after uterine artery embolization(UAE) with or without local methotrexate(MTX) infusion, 10 patients with dilatation and curettage, 6 patients with transvaginal sonographic guided local intragestational MTX injection, and 3 patients with systemic MTX injection. All patients finally recovered. Patients with excessive vaginal hemorrhage underwent either emergency UAE treatment or laparotomy. These two treatments had similar success rates(81.82% vs. 100%, χ2 =0.289, P>0.05). Conclusions The accurate diagnosis of CSP is important. Curettage after UAE with or without local MTX infusion is a safe and effective method. 展开更多
关键词 cesarean scar pregnancy TRANSVAGINAL ultrasound CURETTAGE UTERINE artery EMBOLIZATION LAPAROTOMY
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Management of heterotopic cesarean scar pregnancy with preservation of intrauterine pregnancy:A case report 被引量:2
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作者 Zheng-Yun Chen Yong Zhou +3 位作者 Yue Qian Jia-Min Luo Xiu-Feng Huang Xin-Mei Zhang 《World Journal of Clinical Cases》 SCIE 2021年第22期6428-6434,共7页
BACKGROUND Heterotopic cesarean scar pregnancy(HCSP)is very rare and has a high risk of massive uterine bleeding.Preservation of concurrent intrauterine pregnancy(IUP)is one of the great challenges in the management o... BACKGROUND Heterotopic cesarean scar pregnancy(HCSP)is very rare and has a high risk of massive uterine bleeding.Preservation of concurrent intrauterine pregnancy(IUP)is one of the great challenges in the management of HCSP.No universal treatment protocol has been established when IUP is desired to be preserved.CASE SUMMARY We report a case of HCSP at 8+wk gestation in a 34-year-old woman with stable hemodynamics.A two-step intervention was applied.Selective embryo aspiration was performed first,and surgical removal of ectopic gestational tissue by suction and curettage was performed 2 d later.Both steps were performed under ultrasound guidance.The patient had an uneventful course,and a healthy baby was delivered at 34+6 wk gestation.CONCLUSION Selective embryo aspiration followed by suction and curettage was successful in the preservation of IUP in the management of HCSP.This approach is an alternative option for HCSP in the first trimester when the IUP is desired to be preserved. 展开更多
关键词 cesarean scar Embryo aspiration Heterotopic pregnancy Intervention Suction and curettage Case report
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The Value of Transvaginal Ultrasound in Clinical Surgical Treatment of Cesarean Scar Pregnancy 被引量:4
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作者 曾祯 丁淑萍 +7 位作者 曾雪 曹穗 魏伶羽 刘燕燕 杨福艳 龚静吉 陈汉平 徐晓燕 《Journal of Huazhong University of Science and Technology(Medical Sciences)》 SCIE CAS 2017年第4期536-540,共5页
The clinical value of transvaginal ultrasound in clinical surgical treatment of cesarean scar pregnancy(CSP) was evaluated. The clinical data of 104 patients with CSP admitted at Tongji Hospital from 2013 to 2016 we... The clinical value of transvaginal ultrasound in clinical surgical treatment of cesarean scar pregnancy(CSP) was evaluated. The clinical data of 104 patients with CSP admitted at Tongji Hospital from 2013 to 2016 were collected and analyzed retrospectively, including the patients' age, gestational age, the size of gestational sac or uneven mass, the uterine scar thickness, β human chorionic gonadotropin(h CG) levels and so on. Of these 104 cases, 30 cases were subjected to laparotomy, 29 cases to laparoscopy, 27 cases to hysteroscopy, 16 cases to ultrasound-guided uterine curettage, and 2 cases to conservative treatment. The transvaginal ultrasound showed that uterine scar thickness and gestational sac or uneven mass size had significant difference(P〈0.05) among different surgical methods by comparatively analyzing the patients' data. It was suggested that transvaginal ultrasound may provide the valuable reference for choosing clinical surgical procedures for CSP. 展开更多
关键词 transvaginal ultrasound cesarean scar pregnancy clinical surgical treatment
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Cesarean Scar Pregnancy: A Report of 11 Cases and Review of the Literature Regarding Subsequent Pregnancy 被引量:4
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作者 Chiaki Heshiki Keiko Mekaru +6 位作者 Maho Miyagi Sugiko Oishi Kozue Akamine Hitoshi Sugiyama Tadatsugu Kinjo Hitoshi Masamoto Yoichi Aoki 《Open Journal of Obstetrics and Gynecology》 2016年第1期8-15,共8页
Background: There is no consensus regarding the optimal treatment for cesarean scar pregnancy (CSP) because treatment efficacy, safety, and the influence on subsequent pregnancy must be taken into consideration. Here ... Background: There is no consensus regarding the optimal treatment for cesarean scar pregnancy (CSP) because treatment efficacy, safety, and the influence on subsequent pregnancy must be taken into consideration. Here we report our experience with 11 cases of CSP and review the literature regarding subsequent pregnancy. Methods: Records of 11 CSP cases that were treated at our hospital were retrospectively reviewed. CSP was treated by local methotrexate (MTX) injection or laparotomic or laparoscopic removal of the gestational mass and myometrial repair. Outcome of subsequent pregnancy after treatment was followed-up until delivery. Results: Local MTX injection was performed for six cases, laparotomic removal of the gestational mass and myometrial repair was performed for two, and laparoscopic removal of the gestational mass and myometrial repair was performed for three. The uterus was preserved in all cases. After CSP treatment, eight pregnancies occurred in five cases, resulting in six live births and two miscarriages. Conclusion: Advantages and disadvantages of various treatment methods for CSP continue to be elucidated. Serum hCG level, location of the gestational mass, thickness of the lower uterine segment at the time of diagnosis, and whether the patient wishes for fertility preservation should be considered when choosing a treatment plan. 展开更多
关键词 cesarean scar pregnancy METHOTREXATE Fertility Preservation
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Cesarean scar pregnancy 被引量:1
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作者 Bhusal Miluna Wei Hua 易村犍 《长江大学学报(自科版)(下旬)》 CAS 2013年第12期141-146,共6页
Cesarean scar ectopic pregnancy is a consequence of a scar from previous cesarean section.It is rare and is associated with catastrophic complications of early pregnancy.It can occur in women with only one prior cesar... Cesarean scar ectopic pregnancy is a consequence of a scar from previous cesarean section.It is rare and is associated with catastrophic complications of early pregnancy.It can occur in women with only one prior cesarean delivery.With increasing rate of cesarean section worldwide,more and more cases are diagnosed and reported.The incidence is likely to rise substantially in the near future.A delay in diagnosis and the treatment can lead to uterine rupture,major haemorrhage,hysterectomy and serious maternal morbidity.Early diagnosis can offer treatment options of avoiding uterine rupture and haemorrhage,thus preserving the uterus and future fertility.Aim of this article is to find the demography,pathophysiology,clinical presentation,most appropriate methods of early diagnosis and management. 展开更多
关键词 cesarean scar pregnancy cesarean section
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The Diagnosis and Treatment for a Special Type of Cesarean Scar Pregnancy
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作者 Shili Su Jinping Liu Baihua Dong 《Open Journal of Obstetrics and Gynecology》 2015年第8期427-432,共6页
Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy, and its incidence has been increased due to the increased rate of Cesarean sections performed. A special type of CSP, concealed CSP, was found in the... Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy, and its incidence has been increased due to the increased rate of Cesarean sections performed. A special type of CSP, concealed CSP, was found in the clinical work in our institution. A retrospective review was performed. From September 2011 to June 2014, 208 women were presented with cesarean scar pregnancy by use of transvaginal color Doppler sonography. The medical records were consulted to collect the demographics and pertinent information. Six of them were determined to be concealed CSP. Four women were diagnosed in the first-trimester pregnancy after termination of pregnancy. The initial ultrasound of the other two women displayed that the gestational sacs were located in the lower uterine cavity. Placenta accrete, increta and previa were diagnosed by the following ultrasounds. Concealed CSP is a very unusual form of CSP. Continued pregnancy may be sufficiently evaluated because of subsequently serious complications. Our results indicate that continued pregnancy increases the risk of laparotomy and hysterectomy. Medical abortion in the first-trimester pregnancy should be considered as the optimal choice for the women with prior cesarean sections who want to terminate the gestation. 展开更多
关键词 cesarean scar pregnancy DIAGNOSIS TREATMENT ULTRASOUND
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Clinical observation of hysteroscopic surgery combined with ectopic pregnancy ⅱ decoction and methotrexate in the treatment of cesarean scar pregnancy
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作者 Ai-Li Wang Yan-Xin Chen Li-Xing Cao 《Journal of Hainan Medical University》 2018年第10期34-38,共5页
Objective:To explore the effectiveness and safety about the treatment of Caesarean Scar Pregnancy combined hysteroscopic surgery with extopic pregnancy Ⅱ decoction and methotrexate(MTX).Methods: A total of 80 cases o... Objective:To explore the effectiveness and safety about the treatment of Caesarean Scar Pregnancy combined hysteroscopic surgery with extopic pregnancy Ⅱ decoction and methotrexate(MTX).Methods: A total of 80 cases of CSP patients admitted by our hospital from January 2014 to March 2017 were selected as the subjects. According to the treatment way, the patients were divided into experimental group (n=40) and control group (n=40). The control group was given MTX 50 mg/m2, IM once;and the experimental group was given extopic pregnancy Ⅱ decoction on the basis of the treatment given to the control group;the 8th day hysteroscopic surgery. Routine treatment was given after surgery. Experimental group continued to take extopic pregnancy Ⅱ decoction until monitoring the serum beta-hcg level drops below normal. The general information and curative effect, HCG levels before and after 4, 7 and 11d of treatment;mass diameter before and after 11 d of treatment, menstruation recovery time and the incidence of adverse reactions in 2 groups were observed.Results:After hysteroscopic surgery pretreatment with extopic pregnancy Ⅱ decoction and MTX, HCG levels after 4, 7 and 11d were significantly lower than before, it gradually reduced by time prolonged, and research group was lower than control group, the differences were statistically significant. After treatment with different drugs, the size of pregnancy package in the observation group was significantly smaller than that in the control group. Compared with the control group, the he package block size, beta HCG time and vaginal bleeding time were significantly reduced.Conclusion: It has significant clinical effect of hysteroscopic surgery combined with ectopic pregnancy Ⅱ and MTX in the treatment of CSP. It has worthy of clinical promotion to control the amount of blood, avoid intrauterine adhesion caused by uterine artery embolization and infection et al and reduce burden of the physical and economic of patients. 展开更多
关键词 Extopic pregnancy DECOCTION METHOTREXATE Hysteroscopic Surgery CAESAREAN scar pregnancy cesarean scar pregnancy Efficacy Safety
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Expectant management of cesarean scar pregnancy:a case report and a review of literature
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作者 刘海元 史宏晖 +2 位作者 刘珠凤 冷金花 郎景和 《生殖医学杂志》 CAS 2012年第B12期49-51,共3页
Pregnancy in previous cesarean scar is the rarest form of ectopic pregnancy.Little is known about its natural history and optimal management.All literatures except one reported that the expectant treatments for such p... Pregnancy in previous cesarean scar is the rarest form of ectopic pregnancy.Little is known about its natural history and optimal management.All literatures except one reported that the expectant treatments for such patients were unsuccessful or led to complication.This paper presents one case of cesarean scar pregnancy(CSP) with expectant management,and discusses the value of this expectant management.The paper also appears a glimpse of the natural courses of certain cesarean scar pregnancies. A 32-year-old woman with a history of cesarean section presented to our outpatient clinic with amenorrhea and bleeding.Sonography and magnetic resonance imaging(MRI) revealed the diagnosis of CSP without viable gestation sac.The patient opted for expectant treatment.We closely monitored the patient with a detailed plan.The patient had mild bleeding during monitoring and her serumβ-hCG levels dropped quickly to normal range after seven weeks.She was fully recovered with total absorption of the mixed mass in the scar of the anterior wall of uterus. If patient with CSP has no viable gestation sac and serumβ-hCG levels are rapidly decreased,she can be expectantly treated.Such cesarean scar pregnancies may be naturally demised.Patient with CSP should be followed up strictly.Medical or surgical therapy should be considered prior to rupture to remove the gestational sac and retain the patient future fertility. 展开更多
关键词 剖宫产 化管理 妊娠 瘢痕 病例报告 文献 对症治疗 磁共振成像
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Local metothrexate treatment of cesarean scar ectopic pregnancy
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作者 Davut Güven Kadir Bakay A.Sertac Batioglu 《Open Journal of Obstetrics and Gynecology》 2012年第4期329-330,共2页
Myometrial pregnancy developing in a previous caesarean section scar is the rarest of all ectopic pregnancies (EP) and probably one of the most dangerous of all because of the risk of rupture and hemorrhage. The recen... Myometrial pregnancy developing in a previous caesarean section scar is the rarest of all ectopic pregnancies (EP) and probably one of the most dangerous of all because of the risk of rupture and hemorrhage. The recent recognition of this problem means that diagnosis and management are still in their infancy, and there is no consensus regarding the best management of CSP. Methotrexate (MTX) can be administered systemically or locally, or in both ways, with the aid of ultrasound. Patients diagnosed with caesarean scar pregnancies (CSP) in our clinic underwent transvaginal treatment of ectopic pregnancy. Safe and short treatment under transvaginal ultrasonographic (USG) guidance was performed uneventfully in all cases. The operating time ranged from 5 to 10 minutes with no blood loss. Serum β-hCG (β-subunit of human chorionic gonadotrophin) levels declined to normal levels within a month, and patients were discharged without further complications in two or three hours after the procedure. Our cases show that this treatment is effective, safe, and minimally invasive for patients diagnosed with CSP. 展开更多
关键词 Ectopic pregnancy cesarean Section scar Local MTX Treatment
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术前中西医结合药物预处理在CSP患者宫腔镜下妊娠病灶清除术中的应用价值分析
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作者 任宝红 赵蓉 《中国实用医药》 2024年第14期151-153,共3页
目的探讨术前中西医结合药物预处理在剖宫产术后子宫瘢痕妊娠(CSP)患者宫腔镜下妊娠病灶清除术中的应用价值,为临床治疗提供指导建议。方法回顾性分析72例接受宫腔镜下妊娠病灶清除术治疗的CSP患者的临床资料,随机分为A组(34例)、B组(38... 目的探讨术前中西医结合药物预处理在剖宫产术后子宫瘢痕妊娠(CSP)患者宫腔镜下妊娠病灶清除术中的应用价值,为临床治疗提供指导建议。方法回顾性分析72例接受宫腔镜下妊娠病灶清除术治疗的CSP患者的临床资料,随机分为A组(34例)、B组(38例)。B组患者实施子宫动脉化疗栓塞术(UACE)治疗后行宫腔镜下妊娠病灶清除术,术前无药物预处理;A组患者在UACE治疗基础上实施中西医结合药物预处理后行宫腔镜下妊娠病灶清除术。比较两组围术期相关指标[手术时间、术中出血量、输血量、住院天数、治疗费用、术后血清人绒毛膜促性腺激素(β-hCG)、术后血红蛋白(Hb)、甲氨蝶呤应用剂量]。结果A组的手术时间(22.0±10.8)min短于B组的(79.2±22.0)min、治疗费用(10476.5±2003.2)元低于B组的(12960.5±2888.7)元,差异有统计学意义(P<0.05);两组术后血清β-hCG、术后Hb、术中出血量、输血量、甲氨蝶呤应用剂量、住院天数比较,差异均无统计学意义(P>0.05)。两组患者在治疗过程中均未切除子宫,术后均无残留。结论CSP患者应用中西医结合药物进行预处理后再行宫腔镜下妊娠病灶清除术,手术效果显著,且具有手术时间短、治疗费用低的优势。 展开更多
关键词 中西医结合 药物预处理 宫腔镜下妊娠病灶清除术 剖宫产术后子宫瘢痕妊娠 子宫动脉栓塞
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腹腔镜下妊娠物切除联合宫腔镜探查对CSP患者子宫内膜容受性的影响
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作者 徐伟 丁欢 《中国现代医生》 2024年第21期51-54,共4页
目的分析腹腔镜下妊娠物切除联合宫腔镜探查对Ⅲ型剖宫产术后瘢痕妊娠(caeasrean scar pregnancy,CSP)患者子宫内膜容受性的影响。方法选取2020年1月至2022年1月湖州市中心医院收治的95例Ⅲ型CSP患者的临床资料,根据治疗方式不同分为对... 目的分析腹腔镜下妊娠物切除联合宫腔镜探查对Ⅲ型剖宫产术后瘢痕妊娠(caeasrean scar pregnancy,CSP)患者子宫内膜容受性的影响。方法选取2020年1月至2022年1月湖州市中心医院收治的95例Ⅲ型CSP患者的临床资料,根据治疗方式不同分为对照组(阴式手术局部切除)47例与观察组(腹腔镜下妊娠物切除联合宫腔镜探查)48例。比较两组患者的术后指标、生理应激指标、子宫内膜容受性指标、子宫内膜血流及内膜回声分型。结果观察组患者的阴道流血、人绒毛膜促性腺激素降至正常、月经恢复正常时间短于对照组(P<0.05);并发症发生率低于对照组(2.08%vs.12.76%)(P<0.05);术后两组患者的皮质醇、C反应蛋白均升高,子宫内膜容积、内膜血管指数、血管血流指数均降低,观察组患者的各指标变化幅度大于对照组(P<0.05);治疗后,两组患者的子宫内膜血流、内膜回声分型比较差异有统计学意义(P<0.05),观察组患者的子宫内膜血流分型以Ⅲ型为主(52.08%),对照组以Ⅱ型为主(38.30%);观察组患者的子宫内膜回声以A型为主(54.17%),对照组以B型为主(40.43%)。结论腹腔镜下妊娠物切除联合宫腔镜探查治疗Ⅲ型CSP患者的效果确切,对子宫内膜容受性损伤小,有利于满足患者后期再孕需求。 展开更多
关键词 腹腔镜下妊娠物切除 宫腔镜探查 剖宫产 瘢痕妊娠 子宫内膜容受性
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甲氨蝶呤联合UACE在CSP患者妊娠物清除中应用研究 被引量:1
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作者 施平 耿姣姣 许峰 《河北医学》 CAS 2023年第5期790-794,共5页
目的:探讨甲氨蝶呤联合子宫动脉化疗栓塞术(UACE)在子宫瘢痕妊娠(CSP)患者妊娠物清除中应用效果。方法:选取2020年5月至2021年12月来我院就诊的CSP患者84例,按照随机数字表法分为观察组和对照组,各42例。对照组患者给予甲氨蝶呤治疗,观... 目的:探讨甲氨蝶呤联合子宫动脉化疗栓塞术(UACE)在子宫瘢痕妊娠(CSP)患者妊娠物清除中应用效果。方法:选取2020年5月至2021年12月来我院就诊的CSP患者84例,按照随机数字表法分为观察组和对照组,各42例。对照组患者给予甲氨蝶呤治疗,观察组患者给予甲氨蝶呤联合UACE治疗,比较临床疗效、手术一般情况、妊娠物消失时间和血β-HCG恢复正常时间、卵巢功能指标[卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(PROG)]、并发症发生情况。结果:观察组与对照组总有效率分别为97.62%、83.33%,观察组比对照组高(P<0.05)。观察组术中出血量显著少于对照组,住院时间明显比对照组短(P<0.05),而两组手术时间比较差异不明显(P>0.05)。观察组妊娠物消失时间和血β-HCG恢复正常时间显著早于对照组(P<0.05)。术后3、6个月两组不同治疗方式对患者卵巢功能指标影响无显著差异(P>0.05)。观察组与对照组并发症发生率分别为7.14%、11.90%,差异无统计学意义(P>0.05)。结论:甲氨蝶呤联合UACE对CSP患者疗效较好,可有效改善患者症状,减少术中出血量和缩短住院时间,同时有效清除妊娠物,且对卵巢功能影响较小,并发症少。 展开更多
关键词 甲氨蝶呤 子宫动脉化疗栓塞术 子宫瘢痕妊娠 妊娠物清除
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不同类型剖宫产瘢痕妊娠的病例特点与诊治分析 被引量:2
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作者 王超 侯征 +2 位作者 李华军 李蓉 乔杰 《中国全科医学》 北大核心 2024年第12期1475-1479,1486,共6页
背景现行剖宫产瘢痕妊娠(CSP)分型依据仅参照超声影像特点,目前尚缺乏该分型标准下不同类型CSP病例临床特点的分析总结。目的探讨不同类型CSP的病例特点及诊治差异。方法纳入北京大学第三医院妇产科2014年7月—2022年6月收治的CSP患者共... 背景现行剖宫产瘢痕妊娠(CSP)分型依据仅参照超声影像特点,目前尚缺乏该分型标准下不同类型CSP病例临床特点的分析总结。目的探讨不同类型CSP的病例特点及诊治差异。方法纳入北京大学第三医院妇产科2014年7月—2022年6月收治的CSP患者共862例为研究对象,根据超声分型标准分为Ⅰ型、Ⅱ型、Ⅲ型组,并对其临床特点及诊治指标进行回顾性分析。结果本研究CSP患者中Ⅰ型组占36.5%(315/862),Ⅱ型组占53.1%(458/862),Ⅲ型组占10.3%(89/862)。3组患者的年龄、孕产史、既往宫腔手术史比例比较,差异均无统计学意义(P>0.05)。CSP患者中腹痛发生率为24.2%(209/862),阴道出血发生率为65.0%(560/862)。3组CSP患者腹痛及阴道出血发生率比较,差异均无统计学意义(P=0.261、0.062)。Ⅲ型组患者诊断时停经时间为55(46,64)d,妊娠物中位径线长29.6(19.1,43.3)mm,术前血β-人绒毛膜促性腺激素(β-HCG)水平为60673(17164,122203)mU/mL,需辅助药物杀胚治疗、腹腔镜监视下手术、子宫动脉阻断率分别为27.0%(24/89)、33.7%(30/89)、32.6%(29/89),手术时长101(67,125)min,住院时间4(3,7)d,治疗花费11933.7(8760.7,15250.6)元,术后24 h累计出血量、出血≥200 mL发生率及输血率分别为83(33,178)mL、24.7%(22/89)、7.9%(7/89),均高于其他两组(P<0.001)。所有患者持续性CSP发生率为3.1%(27/862),3组持续性CSP发生率比较,差异无统计学意义(χ^(2)=3.353,P=0.187)。结论不同类型CSP患者的年龄、孕产史、既往宫腔手术史及腹痛、阴道出血等临床特点无明显差异。Ⅰ型和Ⅱ型患者治疗侵入性较小,Ⅲ型患者的医疗资源消耗较多,对多学科团队及个体化管理有较高要求。不同类型患者经规范管理,其治疗预后均较理想。 展开更多
关键词 剖宫产术 瘢痕妊娠 体征和症状 治疗 预后
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剖宫产子宫瘢痕缺损对采用辅助生殖技术孕妇妊娠结局的影响及对策 被引量:1
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作者 王玲 赵晨含 章勤 《浙江大学学报(医学版)》 CAS CSCD 北大核心 2024年第3期313-320,共8页
近二十年中国的剖宫产率持续上升,导致继发性不孕的剖宫产瘢痕缺损(CSD)患者增加,需要通过辅助生殖技术(ART)解决再生育问题。CSD可显著降低ART活产率、临床妊娠率和胚胎植入率,这与患者子宫内膜容受性下降、瘢痕局部发生腺肌病及子宫... 近二十年中国的剖宫产率持续上升,导致继发性不孕的剖宫产瘢痕缺损(CSD)患者增加,需要通过辅助生殖技术(ART)解决再生育问题。CSD可显著降低ART活产率、临床妊娠率和胚胎植入率,这与患者子宫内膜容受性下降、瘢痕局部发生腺肌病及子宫内膜异位症、宫腔微环境紊乱、ART操作难度及妊娠并发症增加有关。除了使用促性腺激素释放激素类似物可能改善妊娠结局,宫腔镜手术、腹腔镜手术和经阴道手术是治疗CSD的有效方法,可提高妊娠率。本文通过文献回顾,分析CSD对采用ART孕妇妊娠结局的影响及相应的治疗方法,以期为CSD患者管理及改善ART妊娠结局提供新思路。 展开更多
关键词 剖宫产 剖宫产瘢痕缺损 辅助生殖技术 妊娠结局 综述
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子宫动脉栓塞术联合病灶清除术在剖宫产瘢痕妊娠治疗中的应用价值研究 被引量:1
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作者 李雪 《陕西医学杂志》 CAS 2024年第3期335-339,共5页
目的:探讨子宫动脉栓塞术(UAE)联合病灶清除术在剖宫产瘢痕妊娠(CSP)治疗中的应用价值。方法:选取CSP患者140例为研究对象,随机分为对照组和UAE组,各70例。对照组给予病灶清除术,UAE组给予UAE联合病灶清除术。比较两组围手术期指标,手... 目的:探讨子宫动脉栓塞术(UAE)联合病灶清除术在剖宫产瘢痕妊娠(CSP)治疗中的应用价值。方法:选取CSP患者140例为研究对象,随机分为对照组和UAE组,各70例。对照组给予病灶清除术,UAE组给予UAE联合病灶清除术。比较两组围手术期指标,手术前后性激素[卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)]水平、子宫动脉血流动力学参数、氧化应激指标,术后恢复指标[β-人绒毛膜促性腺激素(β-hCG)恢复时间、月经复潮时间、术后切口肌层厚度和住院时间]及并发症发生情况。结果:UAE组围手术期指标优于对照组(均P<0.05)。两组性激素水平手术前后比较及组间比较差异无统计学意义(均P>0.05)。术后4个月,血管形成指数(VI)两组均低于术前,且UAE组较对照组更低(均P<0.05);两组丙二醛(MDA)水平高于术前,过氧化氢酶(CAT)和超氧化物歧化酶(SOD)水平低于术前(均P<0.05),且组间MDA、CAT和SOD水平比较差异无统计学意义(均P>0.05)。UAE组术后恢复指标优于对照组(均P<0.05)。术后4个月内,两组并发症发生率比较差异无统计学意义(P>0.05)。结论:UAE联合病灶清除术应用于CSP患者能够缩短手术进程,降低术中和术后出血量,对生育功能影响较小,病灶清除更彻底,术后恢复更快,且安全性较好。 展开更多
关键词 剖宫产瘢痕妊娠 子宫动脉栓塞术 病灶清除术 性激素 血流动力学参数 并发症
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阴式子宫瘢痕妊娠病灶切除联合子宫修补术治疗Ⅱ型/Ⅲ型剖宫产瘢痕妊娠患者的临床疗效
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作者 李燕 耿媛媛 +2 位作者 董君 孙文妹 姚秀玲 《保健医学研究与实践》 2024年第4期61-66,共6页
目的分析阴式子宫瘢痕妊娠病灶切除联合子宫修补术治疗Ⅱ型/Ⅲ型剖宫产瘢痕妊娠(CSP)患者的临床疗效及对患者术后恢复的影响,以期为临床制定CSP的治疗方案提供参考。方法回顾性选取2018年6月—2020年6月衡水市第二人民医院收治的103例Ⅱ... 目的分析阴式子宫瘢痕妊娠病灶切除联合子宫修补术治疗Ⅱ型/Ⅲ型剖宫产瘢痕妊娠(CSP)患者的临床疗效及对患者术后恢复的影响,以期为临床制定CSP的治疗方案提供参考。方法回顾性选取2018年6月—2020年6月衡水市第二人民医院收治的103例Ⅱ型/Ⅲ型CSP患者,根据治疗方式不同分为对照组(50例)和研究组(53例)。对照组患者采用子宫动脉化疗栓塞术联合超声引导下清宫术治疗,研究组患者采用阴式子宫瘢痕妊娠病灶切除联合子宫修补术治疗。比较2组患者的临床疗效、手术指标、术后恢复情况以及治疗前后的孕酮、β-人绒毛膜促性腺激素(β-HCG)水平,同时比较2组患者随访2年的子宫瘢痕妊娠复发及正常妊娠情况。结果研究组患者的治疗总有效率为90.56%(48/53),高于对照组的74.00%(37/50),差异有统计学意义(χ^(2)=4.896,P=0.027)。2组患者治疗前孕酮及β-HCG水平比较,差异无统计学意义(P>0.05);2组患者治疗后孕酮及β-HCG水平均低于治疗前,且研究组均低于对照组,差异均有统计学意义(P<0.05)。研究组患者术中出血量少于对照组,手术时间长于对照组,下床时间、住院时间均短于对照组,差异均有统计学意义(P<0.05)。研究组患者术后正常月经恢复时间、阴道出血时间、β-HCG恢复正常时间、宫腔肿块消失时间均短于对照组患者,差异均有统计学意义(P<0.05)。研究组患者随访2年子宫瘢痕妊娠复发率为0(0/53),低于对照组患者的14.00%(7/50),差异有统计学意义(χ^(2)=5.904,P=0.015)。研究组患者随访2年正常妊娠率为66.04%(35/53),高于对照组34.00%(17/50),差异有统计学意义(χ^(2)=10.564,P=0.001)。结论阴式子宫瘢痕妊娠病灶切除联合子宫修补术治疗Ⅱ型/Ⅲ型CSP患者疗效显著,可减少患者术中出血量,促进患者术后恢复,且降低子宫瘢痕妊娠复发风险,提高正常妊娠率。 展开更多
关键词 阴式子宫瘢痕妊娠病灶切除 子宫修补术 瘢痕妊娠 剖宫产 临床疗效 正常妊娠
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剖宫产术后瘢痕子宫再次妊娠行阴道试产的临床可行性分析
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作者 赵飞 宁方娇 李宁 《中国现代药物应用》 2024年第17期46-49,共4页
目的 研究剖宫产术后瘢痕子宫再次妊娠行阴道试产的临床可行性。方法 选择剖宫产术后再次妊娠行阴道试产的66例产妇作为瘢痕组,另选择同期非瘢痕子宫妊娠行阴道试产的66例产妇作为非瘢痕组。比较两组阴道试产结果,阴道试产成功产妇产程... 目的 研究剖宫产术后瘢痕子宫再次妊娠行阴道试产的临床可行性。方法 选择剖宫产术后再次妊娠行阴道试产的66例产妇作为瘢痕组,另选择同期非瘢痕子宫妊娠行阴道试产的66例产妇作为非瘢痕组。比较两组阴道试产结果,阴道试产成功产妇产程,产后出血量、住院时间及产后胎盘残留发生情况,不良妊娠结局发生情况,新生儿Apgar评分。结果 瘢痕组与非瘢痕组的阴道试产成功率(78.79%VS 84.85%)、转剖宫产率(21.21%VS 15.15%)比较,差异无统计学意义(P>0.05)。瘢痕组阴道试产成功产妇第一、二、三产程及总产程时间与非瘢痕组比较,差异无统计学意义(P>0.05)。瘢痕组产后出血量(210.28±56.36)ml、住院时间(3.69±1.62)d和产后胎盘残留发生率12.12%与非瘢痕组的(205.17±49.69)ml、(3.71±1.59)d、7.58%(5/66)比较,差异无统计学意义(P>0.05)。瘢痕组不良妊娠结局发生率(13.64%)与非瘢痕组(10.61%)比较,差异无统计学意义(P>0.05)。瘢痕组出生后1、5、10 min的新生儿Apgar评分比较,差异无统计学意义(P>0.05)。两组新生儿预后良好,无转入新生儿科记录。结论 剖宫产术后瘢痕子宫再次妊娠产妇的阴道试产成功率与非瘢痕子宫妊娠产妇基本一致,且未增加产程时间及产后出血量,不良妊娠结局发生率无明显升高,临床应用安全性可靠,证实该类产妇经阴道分娩的可行性较强,对提升阴道分娩率及降低剖宫产率具有重要应用价值。 展开更多
关键词 剖宫产 瘢痕子宫 阴道试产 再次妊娠 产后出血 不良妊娠结局
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