妊娠合并宫腔粘连“墙”一例  

A Case Report of Pregnancy Complicated with Uterine Adhesion"Wall"

作　　者：廖代娅 李雪[1] 乔志莉 廖祥余 张科荣[1] LIAO Dai-ya;LI Xue;QIAO Zhi-li;LIAO Xiang-yu;ZHANG Ke-rong(Department of Obstetrics,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan Province,China)

机构地区：[1]川北医学院附属医院产科,四川省南充市637000

出　　处：《国际生殖健康／计划生育杂志》2023年第3期218-221,共4页Journal of International Reproductive Health/Family Planning

摘　　要：近年来,宫腔粘连的发病率呈上升趋势。报告1例足月妊娠合并宫腔粘连“墙”(厚约2.5 cm)的病例。患者因妊娠36^(+2)周,不规律腹痛3 h余入院,既往有2次剖宫产史、1次清宫史,妊娠期多次超声提示宫腔下段呈不均质回声,曾诊断为前置胎盘,入院后因瘢痕子宫行剖宫产术,术中见子宫下段有一腔隙,大小约12 cm×6 cm×4 cm,腔隙顶端呈右至左向下弧形,为肌性组织状,腔内未见妊娠物。遂改用子宫“倒T”切口并彻底切开腔隙顶端的肌性组织,见妊娠羊膜囊,取出胎儿后见胎盘位于子宫后壁,向下覆盖此肌性组织(粘连“墙”)达前壁,人工剥离胎盘后切除肌性粘连“墙”并恢复宫腔解剖,术后恢复良好。通过回顾该病例,总结经验,加强临床及超声医师对宫腔粘连的认识。In recent years,the incidence of uterine adhesion is on the rise.A case of full-term pregnancy with uterine cavity adhesion"wall"(about 2.5 cm thick)was reported.The patient was admitted to hospital for 36^(+2) weeks of gestation and irregular abdominal pain for more than 3 hours.The patient had a history of 2 cesarean sections and 1 uterine curettage.Multiple ultrasound during pregnancy revealed heterogeneous echoes in the lower segment of the uterus,which had been diagnosed as placenta previa.After admission,cesarean section was performed due to scar uterus.During the operation,a cavity was found in the lower segment of the uterus,which was about 12 cm×6 cm×4 cm.The top of the cavity was curved from right to left,which was muscular tissue,and no pregnancy was found in the cavity.After switching to the"inverted T"incision of the uterus and thoroughly cutting open the muscular tissue at the top of the lacuna,the amniotic sac of pregnancy was seen.After the fetus was removed,the placenta was found in the posterior wall of the uterus,covering the muscular tissue(adhesion"wall")down to the anterior wall.After artificial exfoliation of the placenta,the muscular adhesion"wall"was removed and the uterine anatomy was restored.The patient recovered well after operation.Through reviewing this case and summing up the experience,the understanding of uterine cavity adhesion will be strengthen for clinical and ultrasonic doctors.

关 键 词：子宫疾病 组织黏连 妊娠 诊断 超声检查 病例报告 

分 类 号：R714.2[医药卫生—妇产科学]