子宫切口妊娠的诊断及个体化治疗体会

目的探讨子宫切口妊娠的诊断及个体化治疗方案。方法回顾性分析2008年1月～2013年1月我院收治的32例剖宫产切口妊娠的病例资料。结果32例患者中，对于阴道出血多或彩超提示子宫切口厚度≤4mm的19例患者采取子宫动脉介入治疗＋刮宫术，患者介入治疗后阴道出血明显减少，大部分患者刮宫术过程顺利，仅2例切除子宫；11例患者入院前无出血或阴道出血少，彩超提示子宫切口厚度〉4mm．采用甲氨蝶呤肌肉注射＋刮宫术，8例患者刮宫过程顺利，1例切除子宫；2例行米非司酮＋米索前列醇药物流产，胎物自然流出，未清宫。所有患者均痊愈出院，药物治疗7—25d内血HCG下降至正常范围。结论综合患者病灶大小、阴道出血量、子宫切口厚度等指标制定子宫切口妊娠个体化治疗方案，可有效控制大出血，降低刮宫风险，并尽可能保留生育功能，

Diagnosis and individualized treatment about uterine incision pregnancy

Objective To explore the diagnosis and individualized treatment plan for uterine incision pregnancy. Methods The clinical data of 32 cases cesarean section pregnancy from January 2008 to January 2013 were analyzed retrospectively. Results Among 32 patients, there were 19 cases for more vaginal bleeding or ultrasound prompting u- terine incision thickness ≤ 4 mm,these patients were taken to the uterine artery interventional treatment and curet- tage, patients vaginal bleeding was reduced significantly after interventional treatment,most successfully curettage, only 2 cases of hysterectomy. 11 cases of patients with no bleeding or a small amount of vaginal bleeding before ad- mission or ultrasound prompting uterine incision thickness 〉4 mm,these cases were treated with methotrexate intra- muscular injection and curettage, only 1 cases of hysterectomy. 2 patients were given oral administration of mifepris- tone and misoprostol,embryo naturally outflowing without curettage. All patients were cured,serum HCG were de- creased to the normal range after drug treatment for 7-25 days. Conclusion Considering some indicators about pa- tients pregnancy tumor size, amount of vaginal bleeding, the thickness of the uterine incision and to develop uterine incision pregnancy individualized treatment plan, which can effectively control bleeding, reduce the risk of dilatation and curettage, and maximize preserve fertility.