剖宫产子宫疤痕妊娠临床诊治分析

Analysis of clinical diagnosis and treatment of caesarean scar pregnancy

  • 摘要: 目的: 总结剖宫产子宫疤痕妊娠的临床特点、诊治方法及预后。方法: 回顾性分析我院2004-2008年5年期间,诊断为剖宫产子宫疤痕妊娠的7例病例,对临床表现、超声检查、治疗方法的选择及结局进行分析。结果: 7例均经超声确诊,症状出现前获早期诊断者3例,出血均<200mL;其余4例患者出血均>1000mL;保守治疗(氨甲喋呤注射或子宫动脉栓塞/注药)成功6例,子宫切除1例。结论: 疤痕子宫妊娠常导致危及生命的出血,早期诊断、及时处理可减少出血;保守治疗对大部分病例安全有效,子宫动脉栓塞可作为首选治疗。

     

    Abstract: Objective: To describe the clinical characteristics,diagnosis and symptoms of cesarean scar pregnancy(CSP) and evaluate the effects of different treatments. Methods: 7 cases of CSP were retrospectively analyzed.The clinical symptoms,ultrasound image and different treatments were then evaluated. Results: All the 7 cases were diagnosed by transvaginal ultrasound.3 of them were found before any treatment.The 3 early-diagnosed cases were associated with less haemorrhage(<200mL),while the other 4 suffered severe vaginal bleeding(>1 000mL).All the cases were initially managed with conservative treatments including systemically methotrexate(MTX) injection or uterine artery embolization(UAE) with or without intra-arterial injection of MTX.6 of them were successful,and hysterectomy was performed in 1 case at the patient’s insistence. Conclusion: Caesarean scar pregnancy often results in life-threatening vaginal bleeding.Early diagnosis and management could minimize such complications.Conservative treatment may be successful in most cases,and UAE could be the first choice.

     

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