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目的探讨剖宫产后子宫瘢痕部位妊娠的发生、临床特点与处理方法等,进行总结分析。方法回顾性分析郑州市第三人民医院2010年10月份至2011年11月份收治的46例剖宫产后子宫瘢痕部位妊娠患者的临床资料。结果 46例患者均有剖宫产史,其中22例患者首诊误诊,误诊率达47.83%。11例患者在人工流产过程中出现阴道大出血,有9例患者行急诊子宫次全切除术,2例患者通过加用甲氨蝶吟化疗后,治疗成功。22例患者用药物化疗后,再行清宫术,保守治疗成功。13例患者行子宫病灶切除并修补子宫,保留子宫成功。结论有剖宫产史的患者再次受孕时,存在子宫瘢痕部位妊娠的可能性。必须做到早期诊断、早期治疗,确诊后禁止行刮宫术。提高对子宫瘢痕部位妊娠的认识,避免子宫切除,为患者保留生育能力。
Objective To investigate the occurrence of uterine scar pregnancy after cesarean section, clinical features and treatment methods, to conduct a summary analysis. Methods The clinical data of 46 pregnant women with uterine scar after cesarean section were retrospectively analyzed in Zhengzhou Third People’s Hospital from October 2010 to November 2011. Results All the 46 patients had cesarean section history. Among them, 22 cases were misdiagnosed as first diagnosis and 47.83% misdiagnosed. Eleven patients had massive vaginal bleeding during abortion. Nine patients underwent emergency hysterectomy, and two patients were successfully treated with methotrexate chemotherapy. 22 patients with drug chemotherapy, and then curettage, conservative treatment success. Thirteen patients underwent hysterectomy and repair of the uterus, leaving the uterus successful. Conclusions Patients with a history of cesarean section have the possibility of pregnancy at the uterine scar site when they are pregnant again. Early diagnosis must be done, early treatment, curettage after the diagnosis is prohibited. Improve understanding of the uterine scar pregnancy, to avoid hysterectomy, to retain fertility in patients.