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目的:探讨剖宫产术后子宫瘢痕妊娠的诊治方法。方法:对2008年10月~2013年10月诊治的76例子宫瘢痕妊娠患者的临床资料进行回顾性分析。结果:药物加清宫42例,成功39例,成功率为92.85%,其中1例服药过程中出现阴道大量流血,改行栓塞治疗;2例清宫后因hCG下降不满意,进一步行甲氨蝶呤肌注治疗,最终全部病例达治愈标准。栓塞加清宫34例(包括药物失败1例),成功32例,成功率为94.12%,其中1例出现hCG反弹,行甲氨蝶呤治疗后达治愈标准。全部病例进行了2~3个月的随访,均恢复良好。结论:阴道超声检查是诊断CSP的常用方法,米非司酮加清宫术是治疗CSP的有效方法;子宫动脉栓塞加清宫术是治疗CSP确切首选方法,可以迅速准确地控制大出血,对子宫损伤小、术后恢复快。
Objective: To investigate the diagnosis and treatment of uterine scar pregnancy after cesarean section. Methods: The clinical data of 76 cases of uterine scar pregnancy diagnosed and treated from October 2008 to October 2013 were analyzed retrospectively. Results: Forty-two cases were successfully treated with drugs and 39 cases were successful. The success rate was 92.85%. One case was vaginal bleeding in the course of taking medicine, and was diverted to embolization treatment. Two cases were dissatisfied with the hCG decline after the operation in Qing Dynasty. Methotrexate Note treatment, and eventually all the patients up to standard. Thirty-four patients (including 1 failed drug failure) were successfully treated with embolization plus curettage. 32 cases were successful, with a success rate of 94.12%. One case had a hCG rebound and met the standard of methotrexate treatment. All cases were followed up for 2 to 3 months and recovered well. Conclusions: Vaginal ultrasonography is a common method to diagnose CSP. Mifepristone and qi-qing-hong operation is an effective method to treat CSP. Uterine arterial embolization plus hysteroscopy is the first choice to treat CSP, which can control the hemorrhage rapidly and accurately, , Fast recovery after surgery.