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目的 探讨剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)的诊治及预后,减少临床误诊误治。方法 回顾性分析宁德市中医院2002～2011年收治的8例剖宫产术后子宫瘢痕处妊娠患者的临床资料。结果 8例患者平均年龄31.3岁,最常见的临床表现为停经(7例,87.5%)及不规则阴道流血(6例,75.0%),B超提示子宫瘢痕妊娠可能6例。入院后保守治疗成功6例,1例清宫过程大出血行全子宫切除术,1例经手术切除妊娠组织并瘢痕破裂修补。结论 剖宫产术后子宫瘢痕妊娠经阴道超声有助于明确诊断,应用甲氨蝶呤配合B超引导下清宫治疗多数可获成功。
Objective To investigate the diagnosis and treatment of cesarean scar pregnancy (CSP) after cesarean section and to reduce the clinical misdiagnosis and mistreatment. Methods The clinical data of 8 pregnant women with uterine scar after cesarean section were retrospectively analyzed in Ningde Hospital of Traditional Chinese Medicine from 2002 to 2011. Results The average age of 8 patients was 31.3 years old. The most common clinical manifestations were menopause (7 cases, 87.5%) and irregular vaginal bleeding (6 cases, 75.0%). B-ultrasound suggested that 6 cases of uterine scar pregnancy were possible. Conservative treatment after admission was successful in 6 cases, 1 case of hysteroscopic total hysterectomy, 1 case of surgical removal of the pregnancy tissue and scar repair. Conclusions Transvaginal ultrasonography of uterine scar pregnancy after cesarean section is helpful for the definite diagnosis. Methotrexate combined with B-ultrasonography can lead to successful treatment of most of the lesions in the lower uterine cavity.