摘要
目的总结分析剖宫产术后瘢痕妊娠病例的临床诊治经过,探讨剖宫产术后瘢痕妊娠的有效治疗方法。方法对117例确诊为剖宫产术后瘢痕妊娠病例临床诊治经过进行回顾性分析,诊断主要依据B超检查及磁共振检查、全子宫切除标本及病理。治疗主要采用药物治疗、子宫动脉栓塞术联合B超引导下清宫术、宫腹腔镜联合手术治疗和全子宫切除术。结果药物治疗21例,13例成功,8例联合其他方法,成功率为61.9%。对72例剖宫产瘢痕妊娠的患者进行子宫动脉栓塞术,均一次栓塞成功。68例联合B超引导下清宫术后治愈,4例因妊娠组织与瘢痕处粘连致密行宫腔镜手术后治愈。13例行腹腔镜下子宫瘢痕妊娠物清除术及瘢痕修补术,9例行腹腔镜监视下宫腔镜下病灶清除。2例因子宫大出血,无生育要求行全子宫切除术。结论瘢痕子宫妊娠应及早做B超检查,阴超检查对诊断CSP具有重要意义,配合核磁共振检查可确诊CSP。多数CSP患者可行保守治疗,其中子宫动脉栓塞术联合B超引导下清宫术效果显著,创伤小、并发症少,能保留子宫,在有条件的医院可作为首选的治疗方法。
Objective To analyze the clinical diagnosis and treatment of 117 cases of caesarean scar pregnancy and explore the effective treatment method. Methods A retrospective analysis of 117 cases of cesarean scar pregnancy was conducted to analyze the clinical diagnosis and treatment. The diagnosis was based on B ultrasound examinatian, magnetic resonance examination, total hysterectomy specimens and pathology. The treatment methods included drug therapy, uterine artery embolization guided by B ultrasound, hysteroseopy operation, laparoscopy hysteroscopy operation and the combined operation, complete hysterectomy. Results In 21 cases of drug treatment, 13 cases was successful, 8 cases combined with other methods, the success rate was 61.9%. 72 cases were treated successfully with uterine artery embolization. 68 cases were treated successfully with curettage guided by B ultrasound ; 4 cases of pregnancy tissue and sear adhesions were treated successfully with hysteroseopic surgery. 13 patients accepted the dissection of pregnancy and sear repair under laparoscope. 9 patients accepted laparoseopic monitoring hysteroscopic debridement. 2 patients with uterine bleeding, no fertility requirement accepted hysterectomy. Conclusion CSP should be early to do B ultrasonography. Transvaginal ultrasound has an important significance to the diagnosis of CSP. CSP could be diagonsed by transvaginal ultrasound combined with MRI. Conservative treatment is feasible to the majority of CSP patients. The uterine artery embolization combined with B ultrasound - guided curettage has significant effects, small trauma, fewer complications, and can retain the womb. It can be used as the preferred treatment method in conditions of the fully equiped hospital.
出处
《河南医学研究》
CAS
2015年第11期14-16,共3页
Henan Medical Research
关键词
剖宫产瘢痕妊娠
子宫动脉栓塞术
清宫术
cesarean scar pregnancy
uterine artery embolization
uterine curettage
