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目的探讨子宫下段剖宫产瘢痕妊娠治疗策略的选择,为临床合理诊治提供方法及依据。方法回顾性分析38例剖宫产瘢痕妊娠患者的临床资料,分析其诊断及其治疗过程。结果 38例患者均有停经,阴道流血者有32例(84.2%),6例表现为阴道流血伴下腹部轻微疼痛(15.8%),全部伴有血人绒毛膜促性腺激素(HCG)升高。38例均由盆腔彩超检测诊断,32例行药物治疗+清宫术,其中1例行子宫切除术;6例行腹腔镜下子宫切口瘢痕妊娠清除术,过程顺利。结论子宫下段剖宫产瘢痕妊娠的治疗方法多样化,其中甲氨蝶呤(MTX)孕囊内注射后等待HCG下降至1000 U/L后清宫及腹腔镜下病灶切除手术方法出血较少且疗效显著,临床要提高剖宫产瘢痕妊娠的诊断水平,早诊断,早治疗,避免严重并发症的发生,尽可能保留患者生育功能,保证患者生命健康。
Objective To explore the selection of cesarean scar pregnancy treatment strategies in the lower uterine segment and to provide methods and evidences for clinical diagnosis and treatment. Methods Retrospective analysis of 38 cases of cesarean scar pregnancy in patients with clinical data, analysis and diagnosis of the treatment process. Results All 38 patients had menopause, vaginal bleeding in 32 cases (84.2%), 6 cases of vaginal bleeding with mild abdominal pain (15.8%), all accompanied by elevated blood human chorionic gonadotropin (HCG) . 38 cases were diagnosed by pelvic color Doppler ultrasound, 32 cases of cure + curettage, including 1 case of hysterectomy; 6 cases of laparoscopic uterine incision scar removal, the process was smooth. Conclusions Treatment of cesarean scar pregnancy in the lower uterine segment is diversified. Methotrexate (MTX) intrauterine injection of wait for HCG down to 1000 U / L after radical hysterectomy and laparoscopic resection of the lesion less bleeding and curative effect Significantly, clinically to improve the diagnosis of cesarean scar pregnancy, early diagnosis and early treatment, to avoid the occurrence of serious complications, as far as possible to retain the patient’s reproductive function and ensure the patient’s life and health.