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目的:探讨剖宫产术后子宫瘢痕妊娠的诊断及治疗方法。方法:对14例子宫瘢痕妊娠患者的临床资料进行回顾性分析。结果:本组2例因误诊为不全流产、稽留流产行人工流产,术中大出血,行子宫动脉栓塞后清宫治疗。12例经超声检查考虑子宫瘢痕妊娠,6例经MRI检查证实,采用子宫动脉栓塞后行清宫治疗。2例行MTX+米非司酮+米索前列醇+清宫等综合治疗。4例行手术治疗,其中1例腹腔镜手术,1例开腹手术行瘢痕妊娠切除+子宫修补术,2例早期诊断为瘢痕妊娠,坚持妊娠,至中晚期诊断为胎盘植入(其中1例中期妊娠行剖宫取胎,术中大出血,切除子宫;1例至晚期妊娠者剖宫产术中胎盘部分植入大出血,予保留子宫)。结论:超声检查是诊断子宫瘢痕妊娠的简便方法。子宫动脉栓塞可以迅速止血,是安全有效的治疗方法。
Objective: To investigate the diagnosis and treatment of uterine scar pregnancy after cesarean section. Methods: The clinical data of 14 patients with uterine scar pregnancy were analyzed retrospectively. Results: 2 cases of misdiagnosed as incomplete abortion, missed abortion abortion, intraoperative bleeding, uterine artery embolization after curettage. 12 cases of uterine scar pregnancy by ultrasound examination, 6 cases confirmed by MRI examination, the uterine artery embolization line after curettage. 2 cases of MTX + mifepristone + misoprostol + curettage and other comprehensive treatment. 4 cases underwent surgical treatment, including 1 case of laparoscopic surgery and 1 case of open surgery for scar pregnancy and uterine repair. Two cases were diagnosed as scar pregnancy in the early stage and pregnancy was confirmed. One case of placenta accreta was diagnosed in the latter Cesarean section fetus during the second trimester of pregnancy, intraoperative bleeding, removal of the uterus; 1 case of late pregnancy cesarean section in the implantation of placenta hemorrhage, to retain the uterus). Conclusion: Ultrasonography is a simple and convenient method to diagnose uterine scar pregnancy. Uterine artery embolization can quickly stop bleeding, is safe and effective treatment.