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目的:探讨剖宫产子宫切口疤痕妊娠的临床特点和治疗方法。方法:收集2006年8月~2009年8月收治的16例临床病例资料。分析其症状、B超、MRI结果、临床表现、治疗方法及预后。结果:患者平均年龄26岁,均为1次剖宫产史,此次妊娠距前次剖宫产的时间(6月~8年)不等,平均孕龄为52天。4例病例为误诊病例,清宫术中出现阴道大出血,其中2例行开腹疤痕病灶切除术+修补术,2例行子宫次全切术。其余12例为早期诊断病例,予口服米非司酮或联合肌注甲氨喋呤后行腹腔镜或(和)B超监测下清宫术,其中9例成功,3例中转开腹行取胚术+疤痕切除术。结论:剖宫产子宫切口疤痕妊娠发病率呈上升趋势,早期发现可保守治疗,腹腔镜探查术联合B超监测下行清宫术可用于早期诊断,无症状或阴道出血少,孕囊向腔内生长的疤痕妊娠。
Objective: To investigate the clinical features and treatment of cesarean section incision scar pregnancy. Methods: The clinical data of 16 cases admitted from August 2006 to August 2009 were collected. Analysis of the symptoms, B ultrasound, MRI results, clinical manifestations, treatment and prognosis. Results: The mean age of patients was 26 years. All of them were history of one cesarean section. The time from the previous cesarean section (June to 8 years) ranged from 52 days. 4 cases were misdiagnosed cases, vaginal bleeding occurred during the Qing operation, of which 2 cases of laparotomy scar resection + repair surgery, 2 cases of subtotal hysterectomy. The remaining 12 cases were diagnosed early, after oral mifepristone or intramuscular methotrexate laparoscopic or (and) B-monitoring under the curettage, of which 9 cases were successful, 3 cases of laparotomy embryos take embryos Surgery + scar excision. Conclusion: The incidence of cesarean section incision scar pregnancy increased, early detection of conservative treatment, laparoscopic exploration combined with B-scan down curettage can be used for early diagnosis, asymptomatic or vaginal bleeding less, gestational sac growth to the cavity The scar pregnancy.