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目的:探讨剖宫产术后子宫瘢痕妊娠的诊断治疗方法及急诊处理措施。方法:回顾性分析2007-09-2011-09我科住院治疗的剖宫产术后子宫瘢痕妊娠患者临床资料25例。结果:25例患者均有剖宫产史,停经史,血HCG升高。其中10例患者在人流术前阴道超声诊断瘢痕妊娠;13例在人流时出血100～300ml,再经阴道超声诊断;2例人流术中出血800～1000ml休克,急行剖腹探查术中发现。术前明确诊断10例,用米非司酮+MTX+B超宫腔镜下清宫,效果满意;15例人流中出血较多者,其中5例经宫颈注射缩宫素,双合诊按压子宫下段30min后宫腔填塞纱布;另8例用22号Foleys尿管注液20～30ml压迫,术后24～48h取出,行双侧子宫动脉栓塞术,2d后行B超下清宫;2例出血过多伴休克剖腹探查时行子宫下段瘢痕处妊娠组织切除及子宫修补。25例患者均保全了子宫,保留了生育功能。结论:HCG、阴道超声在子宫瘢痕妊娠的诊断中的重要价值。应用米非司酮,MTX或子宫动脉栓塞,用B超或宫腔镜下清宫是治疗子宫瘢痕妊娠的有效方法。宫腔填塞纱布及Fo-leys尿管球囊注液局部压迫,对人流大出血时能取得很好的急诊止血作用,适合基层医院的紧急止血,为进一步及后续保留子宫治疗提供机会。
Objective: To investigate the diagnosis and treatment of uterine scar pregnancy after cesarean section and emergency treatment. Methods: A retrospective analysis of 25 patients with clinical data of uterine scar pregnancy after cesarean section in our department from 2007-09-2011-09 was performed. Results: 25 patients had cesarean section history, menopause, blood HCG increased. Among them, 10 cases were diagnosed with scar pregnancy by vaginal ultrasound before abortion. Thirteen cases had 100-300 ml hemorrhage during the abortion and were diagnosed by transvaginal ultrasonography. Two cases of hemorrhage with 800-1000 ml hemorrhage during abortion were found by emergency laparotomy. Preoperative clear diagnosis of 10 cases, with mifepristone + MTX + B hysteroscopy, the results were satisfactory; 15 cases of bleeding in the human flow were more, of which 5 cases of cervical injection of oxytocin, double compression of the uterus 30 minutes after the lower uterine gauze packing; the other 8 cases with 22 Foleys catheter 20 ~ 30ml oppression, 24 ~ 48h after surgery, bilateral uterine artery embolization, 2 days after the line B ultra-under Qing; 2 cases of bleeding More with laparotomy laparotomy when the lower uterine scar pregnancy pregnancy and uterine repair. All 25 patients preserved the uterus and retained fertility. Conclusion: The value of HCG and vaginal ultrasound in the diagnosis of uterine scar pregnancy. Application of mifepristone, MTX or uterine artery embolization, with B-hysteroscopic or hysteroscopic treatment of uterine scar pregnancy is an effective method. Intrauterine gauze gauze and Fo-leys catheter balloon pressure local oppression, hemorrhage bleeding can make a good emergency hemostatic effect, suitable for emergency stop bleeding at the grassroots hospital for further and subsequent retention of the opportunity to provide treatment for the uterus.