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目的探讨剖宫产术后子宫瘢痕妊娠(CSP)的早期诊断及治疗方法。方法回顾性分析2012年1月至2013年12月阜阳市人民医院收治的29例CSP患者的临床资料,对其诊断、治疗方法及疗效等资料进行临床分析。结果 29例CSP患者中13例误诊为宫内妊娠,其余16例患者结合病史及阴道彩超确诊。29例CSP患者中1例予急诊子宫切除术,1例急诊子宫动脉栓塞术,2例行经阴道病灶切除术,其余25例入院后应用米非司酮、氨甲蝶呤或两药联合应用预处理,15例患者单纯药物治疗成功,2例药物治疗过程中阴道流血量多,予急诊子宫动脉栓塞术成功止血后行宫腔镜病灶切除,余8例患者中2例行宫腔镜下清宫术,3例行宫腔镜下病灶电切术,1例宫腔镜下病灶电切术时阴道流血量多,立即行经腹子宫下段病灶切除术,1例宫腔镜检示子宫憩室妊娠,病灶与膀胱粘连严重,予经腹子宫下段病灶切除术,1例予经阴道子宫瘢痕妊娠切除术。单纯药物治疗失败10例患者经保守手术治疗均治疗成功。单纯药物治疗术后β-人绒毛膜促性腺激素恢复正常时间及阴道流血时间长,月经恢复慢。结论早期诊断及个性化选择保守手术治疗子宫瘢痕妊娠的治疗方法,是治疗成功的关键,可避免切除子宫,缩短患者恢复时间。
Objective To investigate the early diagnosis and treatment of uterine scar pregnancy (CSP) after cesarean section. Methods The clinical data of 29 CSP patients admitted to Fuyang People’s Hospital from January 2012 to December 2013 were retrospectively analyzed. The clinical data of the diagnosis, treatment and efficacy were analyzed. Results Of the 29 CSP patients, 13 were misdiagnosed as intrauterine pregnancy, and the remaining 16 patients were diagnosed by history and vaginal ultrasound. One of 29 CSP patients was given emergency hysterectomy, one case of emergency uterine artery embolization and two cases of transvaginal focal resection. The other 25 cases were treated with mifepristone, methotrexate or two drugs in combination Pretreatment, 15 patients with simple drug treatment was successful, 2 cases of vaginal bleeding during drug treatment, to emergency uterine artery embolization after hysterectomy hysterectomy hysterectomy, the remaining 8 cases of 2 cases under hysteroscopic curettage , 3 cases of hysteroscopic resection of the lesion, 1 case of hysteroscopic resection of vaginal bleeding, and more immediately through the abdominal segment of the hysteroscopic resection, 1 case of hysteroscopic examination of uterine diverticulitis, lesions and Serious adhesion of the bladder to the lower abdominal hysterectomy lesion, a case of transvaginal uterine scar pregnancy resection. Simple drug treatment failed in 10 patients were treated by conservative surgery were successful. Simple drug treatment of β-human chorionic gonadotropin recovery time and vaginal bleeding for a long time, menstruation recovery slow. Conclusion The early diagnosis and personalized choice of conservative surgical treatment of uterine scar pregnancy treatment is the key to the success of treatment, to avoid the removal of the uterus and shorten the recovery time of patients.