多种方法在治疗剖宫产术后子宫瘢痕妊娠中的应用

张长虹; 王晖

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多种方法在治疗剖宫产术后子宫瘢痕妊娠中的应用

张长虹 , 王晖

文章导航 > 蚌埠医学院学报 > 2014, 38 > 3: (339-342)

引用本文:

Citation:

多种方法在治疗剖宫产术后子宫瘢痕妊娠中的应用

张长虹,
王晖

1.
安徽省阜阳市人民医院妇产科, 236000

作者简介: 张长虹(1981- ), 男, 主治医师．

基金项目:

Different procedures for management of caesarean scar pregnancy

1.
Department of Obstetrics and Gynecology, Fuyang People’s Hospital, Fuyang Anhui 236000，China

摘要: 目的:探讨多种方法在治疗剖宫产术后子宫瘢痕妊娠(caesarean scar pregnancy,CSP)中的选择应用及治疗效果。方法:8例CSP患者中,2例外院治疗失败转入后阴道大出血,急诊行子宫动脉栓塞术,术后予甲氨蝶呤化疗。另外6例首诊患者中,1例单纯米非司酮治疗;1例米非司酮联合甲氨蝶呤治疗过程中突发阴道大流血,急诊行子宫动脉栓塞术,1周后行宫腔镜CSP病灶切除术;2例行宫腔镜CSP病灶切除术;1例宫腔镜检术中大出血、1例宫腔镜检发现子宫瘢痕处憩室妊娠,均改行经腹CSP病灶切除修补术。结果:8例患者均治愈,且成功保留子宫。其中1例单纯米非司酮治疗成功;4例药物治疗失败后,2例行宫腔镜手术成功,2例行宫腔镜手术失败,改行经腹手术成功;3例阴道大量出血者行子宫动脉栓塞术成功止血,再予药物或宫腔镜手术治疗成功。结论:CSP的单纯药物治疗以及宫腔镜手术治疗均应掌握一定的适应证,子宫动脉栓塞术可以迅速止血,栓塞术联合药物或手术治疗是可选择的安全有效的治疗方法。
- 剖宫产 /
- 瘢痕妊娠 /
- 甲氨蝶呤 /
- 米非司酮 /
- 宫腔镜 /
- 子宫动脉栓塞
Abstract: Objective:To explore the therapeutic effect of different Methods for management of caesarean scar pregnancy(CSP)． Methods:Eight patients with CSP were included in the study． Two of the cases suffered from vagina bleeding after treatment failure in other hospitals and received emergency uterine artery embolization and methotrexate chemotherapy after surgery，1 case was treated with mifepristone alone，1 case outburst vagina bleeding during the therapy of mifepristone combined with methotrexate，and then underwent emergency uterine artery embolization and hysteroscopy CSP lesion resection 1 week later，2 cases were performed routine hysteroscopy CSP lesion resection and the other 2 cases resorted to abdominal CSP lesion excision repair，for 1 case had intraoperative bleeding in the hysteroscopy check and the other one was found to have uterine scar diverticulum pregnancy by hysteroscopy check． Results:All the 8 cases were cured and the uteri were retained． Among them，1 case treated by only mifepristone achieved successful result，2 cases underwent hysteroscopy surgery after drug treatment failure，and 2 cases resorted to abdominal surgery after drug treatment failure and hysteroscopy surgery failure;3 cases that suffered from serious vagina bleeding got successful hemostasis with uterine artery embolization and then underwent drug therapy or hysteroscopy surgery． Conclusions:Simple drug therapy and hysteroscopy surgery must aim at certain indications，and uterine artery embolization can quickly stop bleeding． Combination therapy of drugs or operation with embolism is safe and effective for management of caesarean scar pregnancy．
- cesarean section /
- cesarean scar pregnancy /
- methotrexate /
- mifepristone /
- hysteroscopy /
- uterine artery embolisation

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多种方法在治疗剖宫产术后子宫瘢痕妊娠中的应用

张长虹
王晖

作者简介: 张长虹(1981- ), 男, 主治医师．

1. 安徽省阜阳市人民医院妇产科, 236000

收稿日期: 2013-07-31
网络出版日期: 2014-03-15

基金项目:

关键词:

摘要: 目的:探讨多种方法在治疗剖宫产术后子宫瘢痕妊娠(caesarean scar pregnancy,CSP)中的选择应用及治疗效果。方法:8例CSP患者中,2例外院治疗失败转入后阴道大出血,急诊行子宫动脉栓塞术,术后予甲氨蝶呤化疗。另外6例首诊患者中,1例单纯米非司酮治疗;1例米非司酮联合甲氨蝶呤治疗过程中突发阴道大流血,急诊行子宫动脉栓塞术,1周后行宫腔镜CSP病灶切除术;2例行宫腔镜CSP病灶切除术;1例宫腔镜检术中大出血、1例宫腔镜检发现子宫瘢痕处憩室妊娠,均改行经腹CSP病灶切除修补术。结果:8例患者均治愈,且成功保留子宫。其中1例单纯米非司酮治疗成功;4例药物治疗失败后,2例行宫腔镜手术成功,2例行宫腔镜手术失败,改行经腹手术成功;3例阴道大量出血者行子宫动脉栓塞术成功止血,再予药物或宫腔镜手术治疗成功。结论:CSP的单纯药物治疗以及宫腔镜手术治疗均应掌握一定的适应证,子宫动脉栓塞术可以迅速止血,栓塞术联合药物或手术治疗是可选择的安全有效的治疗方法。

English Abstract

Different procedures for management of caesarean scar pregnancy

1. Department of Obstetrics and Gynecology, Fuyang People’s Hospital, Fuyang Anhui 236000，China

Received Date: 2013-07-31
Available Online: 2014-03-15

Abstract: Objective:To explore the therapeutic effect of different Methods for management of caesarean scar pregnancy(CSP)． Methods:Eight patients with CSP were included in the study． Two of the cases suffered from vagina bleeding after treatment failure in other hospitals and received emergency uterine artery embolization and methotrexate chemotherapy after surgery，1 case was treated with mifepristone alone，1 case outburst vagina bleeding during the therapy of mifepristone combined with methotrexate，and then underwent emergency uterine artery embolization and hysteroscopy CSP lesion resection 1 week later，2 cases were performed routine hysteroscopy CSP lesion resection and the other 2 cases resorted to abdominal CSP lesion excision repair，for 1 case had intraoperative bleeding in the hysteroscopy check and the other one was found to have uterine scar diverticulum pregnancy by hysteroscopy check． Results:All the 8 cases were cured and the uteri were retained． Among them，1 case treated by only mifepristone achieved successful result，2 cases underwent hysteroscopy surgery after drug treatment failure，and 2 cases resorted to abdominal surgery after drug treatment failure and hysteroscopy surgery failure;3 cases that suffered from serious vagina bleeding got successful hemostasis with uterine artery embolization and then underwent drug therapy or hysteroscopy surgery． Conclusions:Simple drug therapy and hysteroscopy surgery must aim at certain indications，and uterine artery embolization can quickly stop bleeding． Combination therapy of drugs or operation with embolism is safe and effective for management of caesarean scar pregnancy．