剖宫产瘢痕部位妊娠8例分析 |
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【摘要】 目的 探讨剖宫产瘢痕部位妊娠的治疗方法。 方法 回顾分析重庆市妇产科医院6年来收治的8例剖宫产瘢痕部位妊娠的处理,分析其形成原因、早期诊断、处理方式和结局。 结果 8例中仅2例早期B超诊断而转院行介入治疗,6例均误诊,排胎过程中大出血,1例切除子宫,3例行剖腹探查行瘢痕部位切除并修补子宫。 结论 剖宫产瘢痕部位妊娠危险性较大,应严格掌握剖宫产指征。有剖宫产史者早孕流产前应常规彩超检查,警惕剖宫产瘢痕部位妊娠。处理药物治疗首选甲氨喋呤,有子宫破裂者开腹修补为最好的治疗,有大出血风险者可考虑介入治疗。
【关键词】 异位妊娠; 超声诊断
【Abstract】 Objective To explore the treatment on cesarean scar pregnancy (CSP). Methods 8 cases of CSP in Chongqing Women and Children Health Care Hospital in the past 6 years were retrospected. Causes,early diagnosis, treatment and the results were analyzed. Results Only 2 cases were transferred to other hospitals for intervention treatment due to early diagnosis,while the 6 mistakendiagnosed cases experienced massive haemorrhage during labor.Hysterectomy was done in case and transabdominal exploring operation done in 3 cases ,with the scar part removed and repaired.Conclusion CSP is dangerous.The guildline for ceaseren section must be strictly obeyed.The early pregnant woman with uterus cutting history should has routine ultrasonic scan to exclude.MTX is the first choice for medical treatments.Transabdominal exploring operation is the best method for the patient with uterus breaking.Intervention treatment needs to be considered for the patient with the risk of massive haemorrhage.
【Key words】 ettopic pregnancy;ultrasonic diagnosis
剖宫产瘢痕部位妊娠是剖宫产的远期并发症,是一种异位妊娠[1],易造成误诊,易出现严重大出血,处理较为棘手,还可使患者丧失生育功能。作者对1998年2月至2007年5月期间收治的8例剖宫产瘢痕部位妊娠进行回顾性分析。
1 病例资料
1.1 一般资料
本文8例年龄为22~37岁,平均为29岁; 均有剖宫产史,其中1例为3次剖宫产,2例为2次剖宫产,其余5例均为初次剖宫产; 距本次妊娠6月~5年不等,平均2年3个月; 停经时间35~69 d不等。
1.2 临床资料
5例有阴道流血,2例伴轻微腹痛; 3例因重复剖宫产及1例孕69 d住院行药物流产,1例排胎过程中大出血,急行钳夹清宫术,2例因未排胎而进行清宫术,探宫深时即有阴道出 [1] [2] [3] 下一页 |
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