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目的研究剖宫产术后子宫瘢痕妊娠(CSP)的临床表现及诊断治疗方法,为早期诊治及预防提供依据。方法回顾性分析2010年5月-2012年5月收治的14例CSP患者的临床资料,包括CSP患者剖宫产后避孕措施的选择、发生CSP距前次剖官产术的时间、CSP的临床表现、阴道彩色超声的诊断价值、子宫动脉栓塞、甲氨蝶呤辅助等治疗后清宫的疗效。结果 14例CSP患者中仅1例置宫内节育器(IUD),另13例采取工具避孕或者未避孕。距前次剖宫产术时间最短为9个月,最长为8年。14例患者中有12例经阴道超声检查确诊,2例外院误诊为宫内早孕而行人工流产或药物流产失败后转本院经彩超确诊。子宫动脉栓塞术+甲氨蝶呤(9例)、甲氨蝶呤+四氢叶酸(2例)、米非司酮(1例),治疗后清宫12例,期待和保守治疗各1例,均治愈。结论 CSP较少见,彩超在早期诊断方面起重要作用,有效的方法为子宫动脉栓塞术及甲氨蝶呤辅助治疗后行清宫术,剖宫产后及时采取合适的避孕措施,可减少CSP的发生。
Objective To study the clinical manifestations and diagnosis and treatment of uterine scar pregnancy (CSP) after cesarean section and provide the basis for early diagnosis, treatment and prevention. Methods The clinical data of 14 CSP patients admitted to our hospital from May 2010 to May 2012 were retrospectively analyzed, including the selection of contraceptive measures after cesarean section in CSP patients, the time of CSP from the previous cesarean section, the clinical status of CSP Performance, diagnostic value of vaginal color ultrasound, uterine artery embolization, methotrexate-assisted treatment of the efficacy of the Qing. Results Of the 14 patients with CSP, only 1 patient had an IUD, and the other 13 patients took contraceptive or non-contraception. The shortest time from the previous cesarean section was 9 months and the longest was 8 years. 12 of 14 patients were diagnosed by transvaginal ultrasonography, 2 were misdiagnosed as intrauterine pregnancy during second trimester of pregnancy and were diagnosed as abortion or medical abortion by our hospital by color Doppler ultrasound. Uterine artery embolization + methotrexate (9 cases), methotrexate + tetrahydrofolate (2 cases), mifepristone (1 case), after treatment, Qing Gong 12 cases, expectant and conservative treatment in 1 case, All cured. Conclusion CSP is rare, and color Doppler ultrasound plays an important role in early diagnosis. Effective methods include uterine arterial embolization and methotrexate-assisted curettage, and proper contraception after cesarean section can reduce the risk of CSP occur.