妊娠晚期瘢痕子宫不全破裂的临床分析  

Incomplete Uterine Scar Rupture in Late Pregnancy:Clinical Analysis of 13 Cases

作　　者：蔡瑞贤[1] 戴婉波[1] 覃小红[1] 黄丽萍[1] 黄珍[1] 

机构地区：[1]广州医学院附属深圳沙井医院产科,广东深圳518104

出　　处：《华西医学》2010年第2期278-279,共2页West China Medical Journal

摘　　要：目的探讨瘢痕子宫不全破裂的早期诊断、处理及预防。方法2006年1月-2009年1月发生瘢痕子宫不全破裂13例,术前临床症状加B超检查确诊,手术从原切口进入宫腔,取出胎儿,修剪原切口周围瘢痕组织,1-0可吸收线连续缝合浆肌层,再间断包埋缝合切口,术后常规预防感染,加强宫缩治疗;胎盘植入2例尽量取出胎盘,修整切口,活动性出血明显者用1-0可吸收线"8"字缝扎止血,术后加服米非司酮150mg/d共3d。结果母婴均痊愈出院。42d后来院复查,B超探查8例子宫下段处有线状较强回声,肌层回声均匀,余未发现异常;胎盘植入2例,随防3个月血绒毛膜促性腺激素呈阴性。结论早期B超检查能提高瘢痕子宫不全破裂确诊率,确诊后急诊剖宫产,胎盘部分植入者加服米非司酮并预防感染。Objective To explore the early diagnosis,treatment and prevention of the incomplete uterine scar rupture.Methods From January 2006 to January 2009,13 patients with incomplete uterine scar rupture were studied.The preoperative diagnosis was made according to the clinical symptoms plus B-ultrasonography.Surgical incision into the uterine cavity was performed from the original incision site,the fetus was removed out,the surrounding scar tissue of the original incision was pruned,the pulp-muscle layer was sewed up continuously with a 1-0 absorbable suture,and then the incision was embedded and sewed up by the interrupted suture.The infection was prevented routinely after strengthening the uterine contraction treatment.In 2 cases of placenta accreta,the placenta was tried to be removed out,and the incision was repaired.When active bleeding happened obviously,1-0 absorbable thread ＂8＂ suture was performed to stop the bleeding.Postoperative mifepristone 150 mg/d was given for a total of 3 days.Results All mothers and their healthy babies were discharged,and 42 days later all of them were followed up.In B-ultrasonography,a strong linear echo,with muscular uniform was present in uterine lower segment in 8 cases.No abnormality was found in other cases.Two cases of placenta accreta had negative blood human chorionic gonadotropin in three-month＇s follow-up.Conclusion Early B-ultrasonography can improve the diagnosis rate of incomplete uterine scar rupture.Emergency operation after the diagnosis,mifepristone for placental part implant,strict indications for cesarean section and the correct choice of surgical incision,improvement of surgical skills and suture techniques,prevention of infection can reduce the opportunity for the next uterine scar rupture.

关 键 词：妊娠晚期 瘢痕子宫 不全破裂 胎盘植入 治疗 

分 类 号：R714.2[医药卫生—妇产科学]