剖宫产瘢痕部位妊娠止血方法的临床分析  

Clinical Analysis on Hemostasis Ways in Cesarean Scar Pregnancy

作　　者：诸葛听[1] 徐嬿[1] 黄紫蓉[1] 李斌[1] 

机构地区：[1]复旦大学附属妇产科医院,上海200011

出　　处：《生殖与避孕》2012年第11期760-764,共5页Reproduction and Contraception

摘　　要：目的:探讨剖宫产瘢痕部位妊娠(cesarean scar pregnancy,CSP)出血的止血方法及其适应证。方法:对95例CSP出血患者依据止血方法不同分为4组,A组采用纱条填塞压迫宫腔下段及切口处止血;B组采用Foley导管压迫宫腔下段及切口处止血;C组采用经腹或腹腔镜下病灶切除术止血;D组采用子宫动脉栓塞术(uterine artery embolization,UAE)止血。回顾性分析其临床资料。结果:患者治疗前估计出血量、停经天数、治疗前血β-hCG值、超声显示孕囊或胚胎组织物3径线之和的平均数,超声显示妊娠物距浆膜面的组织厚度4组间的比较,差异有统计学意义(P<0.05)。治疗后的出血量和治疗前后血红蛋白(Hb)的变化值,4组间比较差异有统计学意义(P<0.05)。结论:4种止血方法在治疗中均成功止血,临床工作中依据患者病情的不同需要,可以独立应用,也可以同时或交叉应用,并结合以往的临床经验,对患者采取个性化的治疗,可达到保留患者的生育能力、减少出血等并发症效果。Objective： To discuss the treatment effect and indication of the cases of hemorrhage in cesarean scar pregnancy. Methods： Totally 95 cases of hemorrhage in cesarean scar pregnancy were divided into 4 groups according to the hemostasis methods. Group A （n=15）, hemostasis done by oppression at lower part of uterine section and the cut with the article yam; group B （n=34）, hemostasis done by oppression at lower part of uterine section and the cut with the Foley catheter; group C （n=15）, hemostasis done by using abdominal or laparoscopic resection of the lesions bleeding; group D （n=31）, hemostasis done by the uterine artery embolization （UAE）. The clinical data were retrospectively analyzed. Results： There were statistically significant differences in assuming bleeding volume before treatment, amenerrheic periods, blood level of β-human chorionic gonadotrophin （hCG） before treatment, the average value of the sum of 3 radial lines of gestational sac or embryo displayed via ultra- sonic, comparison and deviation of tissue thickness between pregnancy substance and serous membrane via ultra- sonic among the four groups （P〈0.05）. There were statistically significant differences in bleeding volume and deviation of hemoglobin before and after treatment among the four groups （P〈0.05）. Conclusion： All these 4 kinds of hemostasis methods are successful. It can be implemented independently or mixed according to the specific situation of patients. It＇s possible to setup the personalized treatment to try our best to save the potentia generandi and reduce the complication such as hemorrhage.

关 键 词：剖宫产瘢痕部位妊娠(CSP) 出血 治疗 

分 类 号：R714.22[医药卫生—妇产科学]