剖宫产术后瘢痕妊娠临床治疗分析

目的:探讨剖宫产术后瘢痕妊娠的临床特点及治疗方法。方法:对7例剖宫产术后瘢痕妊娠患者的临床资料及治疗结果做回顾性分析。结果:7例患者均有剖宫产史,3例因人工流产术后阴道大量出血急诊入院,术前均被误诊;2例以"不全流产"、"胎停育"收入院,清宫术中阴道大出血;另2例早孕,因术前诊断明确,采取有效治疗措施,避免了人工流产术中大出血。7例患者中,2例行子宫切除术,1例行子宫下段瘢痕病灶楔形切除术+子宫修补术,2例行甲氨蝶呤(MTX)介入+超声监护下刮宫,2例行MTX+米非司酮+超声监护下刮宫。结论:剖宫产术后瘢痕妊娠较少见,临床易误诊,对有剖宫产史的患者应结合妇科检查及其他辅助检查以早诊断、早治疗,避免漏诊、误诊,可获得较好的治疗效果。

Analysis on clinical treatment of cesarean scar pregnancy

Objective:To explore the clinical characteristics and therapy of cesarean scar pregnancy(CSP). Methods:The clinical data and curative results of seven patients with CSP were analyzed retrospectively. Results:All the seven cases had history of cesarean section,three patients went to the hospital emergently because of massive vaginal hemorrhage after artificial abortion,all the three patients were misdiagnosed;two patients were admitted to the hospital because of "incomplete abortion" and "suspending embryo growth",massive vaginal hemorrhage occurred during uterine curettage;the other two patients were found with early pregnancy,effective therapy was adopted because of definite diagnosis before surgery,massive hemorrhage during artificial abortion was avoided.Among seven patients,two patients underwent hysterectomy,one patient underwent wedge resection of scar in lower uterine segment and uterine repair,two patients underwent interventional therapy with Methotrexate and uterine curettage under ultrasonic monitoring,two patients were treated with Methotrexate,Mifepristone,and uterine curettage under ultrasonic monitoring. Conclusion:CSP was uncommon,and it is easy to be misdiagnosed,the patients with history of cesarean section should be diagnosed and treated early to avoid misdiagnosis and missed diagnosis combined with gynecological examination and other assistant examinations,then a good curative effect can be obtained.