摘要
目的探讨子宫剖宫产瘢痕妊娠(cesarean scarpregnancy,CSP)的超声诊断价值以及子宫动脉栓塞甲氨蝶呤(methotrexate,MTX)治疗后腹腔镜监视下刮宫术在CSP治疗中的价值。方法回顾性分析2008年1月—2011年6月53例CSF患者的临床资料。结果 B超检查联合彩色多普勒血流显像对53例子宫剖宫产瘢痕处早期妊娠的超声声像图表现做回顾性分析,术前超声明确诊断50例(94.3%),漏诊3例(5.7%)。53例患者子宫动脉栓塞联合MTX治疗后24～48h内行腹腔镜监视下刮宫术,其中手术成功51例(96.2%),刮宫术中子宫穿孔,腹腔镜下行子宫修补术2例(3.8%)。51例成功者术中出血20～80mL,平均(34±12)mL,53例患者术后3d血人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)明显下降,2周复查血β-HCG均正常,术后1个月复查超声均无残留,随访均在1～2个月月经来潮。结论 B超检查联合彩色多普勒血流显像是诊断CSP的首选和最佳方法。子宫动脉栓塞在CSP的治疗中,能迅速止血并且保证刮宫术的安全性,腹腔镜监视下有效杜绝了子宫穿孔后引起的并发症,提供了安全、有效的治疗方法。
Objective To investigate the value of ultrasound in the diagnosis of cesarean scar pregnancy （CSP） and dilatation and curettage under laparoscopic surveillance after uterine artery embolization combined with methotrexate （MTX） in the treatment of CSP. Methods The clinical data of 53 cases of CSP from January 2008 to June 2011 were retrospectively analyzed. Results B - ultrasound combined with color Doppler flow imaging （CDFI） showed that 50 cases （ 94.3% ） were before operation and 3 cases （5.7 and curettage under laparoscopic combined with MTX treatment, of diagnosed % ） were missed diagnosed. Fifty - three patients underwent dilatation surveillance within 24 -48 hours after uterine artery embolization which the operation was successful in 51 cases （96.2%）, uterine perforation occured during dilatation and curettage in 2 cases （3. 8% ）, which were repaired under laparoscopy. The intraoperative blood loss of 51 cases whose operations were successful was 20 -80mL with an average of （34 _＋ 12）mL. The serum 13 -human chorionic gonadotropin （13 -HCG） decreased obviously 3 days after operation and recovered to normal level 2 weeks after operation. The ultrasound 1 month after operation showed no residue. All the patients had their menses recovered in 1 -2 months follow- up. Conclusion B -ultrasound combined with CDFI is the preferred and best method for diagnosis of CSP. Uterine artery embolization in the treatment of the CSP can quickly stop the bleedingand ensure the security of dilatation and curettage, laparoscopic monitoring can effectively eliminate the complications caused by perforation of the uterus, and provide a safe and effective treatment.
出处
《河北医科大学学报》
CAS
2012年第7期772-775,共4页
Journal of Hebei Medical University
关键词
妊娠
瘢痕
超声检查
治疗
pregnancy
cicatrix
uhrasonography
therapy
