48例剖宫产瘢痕妊娠临床资料分析  

Analysis of clinical data of 48 cases of cesarean scar pregnancy

作　　者：刘立峰[1] 董雨林 金仙玉[1] LIU Li-feng;DONG Yu-lin;JIN Xian-yu(Department of Obstetrics and Gynecology,Dalian Central Hospital,Dalian 116023,China)

机构地区：[1]辽宁省大连市中心医院妇产科,116023

出　　处：《中国现代药物应用》2020年第21期34-37,共4页Chinese Journal of Modern Drug Application

摘　　要：目的分析48例剖宫产瘢痕妊娠患者的临床资料,探讨不同临床类型剖宫产瘢痕妊娠的手术方式。方法回顾性分析48例剖宫产瘢痕妊娠患者的临床资料,进行临床分型,调查不同临床分型患者的手术情况。结果36例Ⅰ型、Ⅱ型患者瘢痕处子宫肌层厚度≥1 mm,全部采用经腹超声监视下负压吸宫术,均成功清除妊娠物,未发生大出血及子宫瘢痕处穿孔。12例Ⅲ型患者,瘢痕处无外凸包块者4例,采用腹腔镜监视下吸宫术,其中2例患者术中出血少,1例患者术中出血较多经宫腔内置入球囊压迫后出血明显减少,这3例患者因无再次生育要求均未行剖宫产瘢痕切除修补术,另外1例行吸宫术时子宫瘢痕处破裂,行腹腔镜下瘢痕切除修补术。8例瘢痕处向膀胱方向外凸包块的患者行腹腔镜下瘢痕切除修补术,术中膀胱破裂1例,其余7例手术均无大出血、损伤等并发症。结论根据剖宫产瘢痕妊娠超声表现进行精准分型,对手术方式的选择具有重要的指导意义。Ⅰ型、Ⅱ型可以在充分准备情况下行超声监视下负压吸宫术,Ⅲ型最好行腹腔镜监视下负压吸宫术,且很可能需要行瘢痕切除修补术。Objective To analyze the clinical data of 48 cases of cesarean scar pregnancy,and discuss the surgical methods of different clinical types of cesarean scar pregnancy.Methods The clinical data of 48 cases of cesarean section scar pregnancy patients were retrospectively analyzed,and the clinical classification was performed to investigate the surgical approaches of patients with different clinical classifications.Results The thickness of muscle layer was≥1 mm in 36 cases of type Ⅰ and type Ⅱ CSP.All of them have been performed vacuum aspiration under ultrasonic monitor successfully without complications of bleeding or scar perforation.Among 12 cases of type Ⅲ CSP,4 cases without outer-convexing mass on scar had taken laparoscopic negative pressure aspiration,2 cases of which had less bleeding,1 case of which took intrauteral-balloon compression hemostasis.All 3 cases had no tendency to get pregnancy again,so they didn’t take laparoscopic debridement,and 1 case had scar rupture during aspiration which resulted in laparoscopic debridement.The other 8 cases with bladder-convexing mass on scar had taken laparoscopic debridement,and 1 case had bladder rupture,while the others had no severe complications.Conclusion It is necessary to make a precise ultrasonic classification before make a decision on an appropriate surgical approach of CSP.Vacuum aspiration under ultrasonic monitor is suitable to type Ⅰ and type Ⅱ CSP,while as far as type Ⅲ CSP is concerned,laparoscopic vacuum aspiration or laparoscopic debridement is needed.

关 键 词：剖宫产子宫瘢痕妊娠 彩超 负压吸宫术 腹腔镜子宫瘢痕切除修补术 

分 类 号：R714.22[医药卫生—妇产科学]