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目的探讨剖宫产术后子宫瘢痕处妊娠的诊断和治疗方法。方法回顾性分析四川大学华西第二医院2005年1月至2009年6月收治的103例剖宫产术后子宫瘢痕处妊娠患者的临床资料。结果 103例患者中治疗前明确诊断50例,误诊53例。病灶清除或杀胚后病灶清除88例,成功率92.0%(81/88)。单纯杀胚治疗15例,其中1例介入后即要求出院,并失去随访,不纳入统计,成功率57.1%(8/14)。两种方法的治愈率差异有统计学意义(χ2=13.26,P<0.05)。结论阴道彩超的应用可使剖宫产术后子宫瘢痕处妊娠早期确诊。病灶清除能提高本病的治愈率。病灶清除的方法依病灶侵入的深度不同而异。为避免大出血及子宫切除,病灶深入肌层者应首选开腹或腹腔镜下病灶切除。
Objective To investigate the diagnosis and treatment of uterine scar pregnancy after cesarean section. Methods The clinical data of 103 pregnant women with uterine scar after cesarean section were analyzed retrospectively from January 2005 to June 2009 in Huaxi Second Hospital of Sichuan University. Results Among 103 patients, 50 cases were diagnosed before treatment and 53 cases were misdiagnosed. 88 cases of lesions were cleared or killed, the success rate was 92.0% (81/88). Fifteen cases were treated by killing the embryos alone. One patient intervened and discharged at the time of follow-up, and were excluded from the statistics. The success rate was 57.1% (8/14). The two methods of cure rate difference was statistically significant (χ2 = 13.26, P <0.05). Conclusion The application of vaginal ultrasound can make uterine scar after cesarean section at early pregnancy diagnosis. Lesions can improve the cure rate of the disease. The method of lesion clearance depends on the depth of invasion of the lesion. In order to avoid bleeding and hysterectomy, lesions should be preferred deep laparotomy or laparoscopic resection of the lesion.