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目的:探讨剖宫产术后子宫疤痕部位妊娠的临床诊断方法与治疗分析,提高对瘢痕部位的妊娠诊断率以及总结有效的治疗。方法:2010年11月以来,我院共收治剖宫产术后疤痕部位妊娠患者20例,采用彩超诊断,依据临床表现,采用不同的治疗方法。结果:20例患者依据均行彩超检查确诊,20例患者给予甲氨蝶吟(MTX)联合米非司酮治疗后,监测阴道彩超血流基本消失情况,16例患者行清宫术,2例彩超血流未全消失清宫术时大出血行子宫峡部疤痕部位切除修补术,2例转诊者,因诊断不明确,均需手术治疗;其中1例行全宫切除,1例行子宫峡部疤痕部位切除修补术。结论:剖宫产术后疤痕部位妊娠,彩超能够明确诊断,及时适当的治疗能减少大出血的发生,有利于保留生育功能。
Objective: To investigate the clinical diagnosis and treatment of uterine scar pregnancy after cesarean section, and to improve the diagnosis of pregnancy in scar site and to summarize the effective treatment. Methods: Since November 2010, 20 cases of pregnancy in patients with cesarean scar after cesarean section have been treated in our hospital. The patients were diagnosed by color Doppler ultrasound. Different treatment methods were used according to the clinical manifestations. Results: Twenty patients were diagnosed by color Doppler ultrasonography. Twenty patients were treated with methotrexate (MTX) and mifepristone, and the disappearance of vaginal bleeding was monitored. Sixteen patients underwent radical hysteroscopy and two cases of ultrasonography Blood flow did not disappear during the curettage of hemorrhage line isthmus scar excision and repair, 2 cases of referral, due to the diagnosis is not clear, require surgical treatment; 1 case of total hysterectomy, 1 case of isthmus scar site excision Repair surgery. Conclusion: After the cesarean section of the scar pregnancy, color Doppler ultrasound can confirm the diagnosis, timely and appropriate treatment can reduce the incidence of major bleeding, help to retain the reproductive function.