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目的探讨剖宫产疤痕妊娠的临床特点,发病因素和早期诊断及恰当的治疗方法。方法回顾性分析6例剖宫产疤痕妊娠患者的临床资料及治疗结局。结果6例患者均有剖宫产史、4例因人工流产术后及钳刮术中阴道大量出血急诊入院,术前均被误诊。1例因孕37周产前出血,前置胎盘、疑胎盘植入急诊入院。另1例早孕停经51d,因术前彩超确诊剖宫产疤痕妊娠提前采取了处理措施,避免了人流术中大出血,这6例中有2例行子宫次全切除术,2例行子宫下段疤痕病灶楔形切除术+子宫修补术,2例行MTX化疗+MTX介入+超声监护下刮宫。结论剖宫产疤痕妊娠较少见,临床易误诊,对有剖宫产史的患者应结合妇科检查及辅助检查以早期诊断、强调根据患者予以个体化治疗,可获得较好的疗效。
Objective To investigate the clinical features, pathogenesis, early diagnosis and proper treatment of cesarean scar pregnancy. Methods Retrospective analysis of 6 cases of cesarean scar pregnancy in patients with clinical data and treatment outcomes. Results All 6 patients had history of cesarean section. Four patients were admitted to hospital due to massive vaginal bleeding during induced abortion and forceps curettage. All patients were misdiagnosed before operation. A case of 37 weeks pregnant prenatal bleeding, placenta previa, suspected placenta accreta emergency hospitalization. Another 1 case of early pregnancy menopause 51d, due to preoperative ultrasound diagnosis of cesarean section scar pregnancy early take measures to avoid bleeding in abortion, of which 6 cases of subtotal hysterectomy 2 cases of lower uterine scar Lesions wedge resection + uterine repair, 2 cases of MTX chemotherapy + MTX interventional + ultrasound monitoring curettage. Conclusion Cesarean scar pregnancy is rare, clinical misdiagnosis, patients with history of cesarean section should be combined with gynecological examination and auxiliary examination to early diagnosis, emphasizing individualized treatment according to patients, can obtain better curative effect.