剖宫产术后子宫瘢痕部位妊娠10例临床分析  

Clinical analysis on 10cases of pregnancy within caesarean section scars

作　　者：刘洋[1] 杨茜茜[1] 宋英慧[1] 刘宁[1] 王彤[1] 南云泽[1] 

机构地区：[1]延边大学附属医院妇产科,吉林延吉133000

出　　处：《延边大学医学学报》2013年第2期135-138,共4页Journal of Medical Science Yanbian University

摘　　要：[背景]探讨剖宫产术后子宫切口瘢痕处妊娠的诊断及治疗方法.[病例报告]对2011年1月—2012年6月间收治的10例子宫下段剖宫产术切口瘢痕处妊娠病例的临床资料进行回顾性分析.10例均有剖宫产术史,停经后不规则阴道流血,经彩色多普勒超声及血β-HCG检测,10例患者全部明确诊断.10例中8例经彩色多普勒超声检查发现子宫下段切口瘢痕处妊娠囊距子宫浆膜层厚度在4mm以上,2例不足4mm.8例口服米非司酮及米索前列醇配合刮宫术治疗,7例获痊愈,1例患者因刮宫术后阴道持续活动性出血,行子宫动脉栓塞术,术后无活动性出血.2例患者进行子宫动脉栓塞术、MTX50mg子宫动脉内注入,3d后刮宫治疗成功.[讨论]子宫下段剖宫产术后切口瘢痕处病灶距子宫浆膜层厚度可作为选择治疗方法的参考依据,其中给距离大于4mm者行口服米非司酮及米索前列醇后行刮宫术可获较满意的效果,小于4mm者则可依据具体情况改用子宫动脉栓塞术等治疗方法.BACKGROUND To study the diagnosis and treatment for pregnancy within cesarean section scars. CASE REPORTS The clinical data for 10 cases of pregnancy within caesarean section scars were retrospectively analyzed from Jan, 2011 to Jun, 2012. 10 cases had a history of cesarean section, irregular vaginal bleeding after menopause, and pregnancy diagnosed by color doppler ultrasound and blood beta HCG detection. 8 cases had more than 4 mm of thickness from gestational sac to uterine serosa layer at lower uterine segment scar incision by color doppler ultrasound examination, and 2 cases had less than 4 ram. 8 patients were treated by administration with oral mifepristone and misoprostol cooperated with dilatation and curettage, in witch 7 cases had recovered and 1 cases was performed by using uterine artery embolization and had no postoperatively active bleeding because of keeping on continued active vaginal bleeding after uterine curettage. 2 patients were treated by the uterine artery embolization with infusing 50 mg of MTX to uterine artery, and the treatment with dilatation and curettage was successful after 3 days. DISCUSSION The thickness from gestational sac to uterine serosa layer at lower uterine segment in pregnancy within caesarean section scars can be used as the reference for selecting the treatment method, and the patients with more than 4 mm of thickness are treated by administration with oral mifepristone and misoprostol cooperated with dilatation and curettage and get a satisfying therapeutic effects, and the patients with less than 4 mm of thickness can be treated by uterine artery embolization in accordance to specific conditions.

关 键 词：剖宫产瘢痕处妊娠 刮宫术 米非司酮 米索前列醇 

分 类 号：R714.2[医药卫生—妇产科学]