剖宫产瘢痕部位妊娠子宫动脉栓塞术后近远期并发症分析

目的:探讨不同类型剖宫产瘢痕部位妊娠(CSP)患者行子宫动脉栓塞术(UAE)后近远期并发症的发生率。方法:回顾性队列研究。纳入2012年8月—2020年8月山西医科大学第三医院妇产科CSP患者112例,均采用UAE联合超声引导下清宫术治疗。患者年龄22~42(32.79±5.16)岁,剖宫产次数1~3[1(1,2)]次...     

剖宫产术后早期子宫瘢痕部位妊娠11例临床分析

目的探讨剖宫产术后子宫瘢痕部位妊娠（CSP）早期诊断及治疗方法。方法对2002年至2008年我院收治的11例剖宫产瘢痕部位妊娠患者资料进行回顾分析。结果11例病例临床表现缺乏特异性,4例误诊为宫内早孕;1例误诊为滋养细胞疾病而给以化疗。阴道大出血4例给予子宫动脉栓塞后行清宫术;氨甲喋呤联合米非司酮治疗6例,4例成功,2例失败后行开腹局部病灶切除术。所有患者均痊愈出院,随诊HCG值至正常。结论超声检查是诊断CSP的简单可靠方法;子宫动脉栓塞可以迅速止血,栓塞后联合药物或手术治疗是安全有效的治疗方法,刮宫术前需用氨甲蝶呤联合米非司酮进行有效地杀胚治疗。     

剖宫产瘢痕妊娠病灶切除术与子宫动脉栓塞术后 清宫的效果比较

目的 比较剖宫产瘢痕妊娠病（CSP）灶切除与子宫动脉栓塞后清宫的临床效果。方法 回顾性分析2015年1月~2018年6月我院收治的110例剖宫产瘢痕妊娠患者的临床资料,根据手术方式分为手术组（52例）和清宫组（58例）,手术组行瘢痕病灶切除术,清宫组同期行子宫动脉栓塞后清宫,比较两组术中出血量、血HCG下降至正常的时间、住院费用及术后第1次月经量改变情况。结果 手术组平均出血量为（80.59±17.12）ml,高于清宫组的（8.65±1.53）ml,差异有统计学意义（P＜0.05）;手术组血HCG下降至正常时间为（22.40±7.45）d,少于清宫组的（31.80±8.24）d,差异有统计学意义（P＜0.05）;两组住院费用比较,差异无统计学意义（P＞0.05）;清宫组有9例出现术后第1次月经量减少,手术组无患者发生月经量改变。结论 瘢痕妊娠病灶切除与子宫动脉栓塞后清宫的住院费用相当,但子宫动脉栓塞后清宫有瘢痕持续存在、术后血HCG下降缓慢、部分患者出现月经量减少的缺点,故对于肌壁厚度＜4 mm,有再生育要求的CSP患者,瘢痕病灶切除术应作为首选的治疗措施。     

剖宫产术后子宫瘢痕处早期妊娠16例临床分析

目的 分析探讨剖宫产术后子宫瘢痕处妊娠(CSP)的诊断和治疗方法.方法 回顾性分析我院收治子宫瘢痕处妊娠患者16例,分析其B超检查、治疗相关预后情况.结果 14例保守治疗治愈,2例保守治疗失败行子宫次全切除术.结论 CSP是一种严重危害孕妇的并发症,一旦确诊断,应尽早终止妊娠.     

剖宫产术后子宫瘢痕妊娠经阴切除病灶术的临床应用

目的探讨剖宫产术后子宫瘢痕妊娠经阴切除病灶术方法的临床应用。方法对我院自2010年11月~2013年10月11例子宫瘢痕妊娠经阴道切除病灶术,术前查血β-HCGB值及B超检查,分I、I 型,术中缩宫素或垂体后叶素注射于子宫肌壁,术后复查血β-HCG值。结果11例子宫瘢痕妊娠患者均在阴式手术下完成,0例中转开腹手术者。无1例切除子宫;无1例膀胱、尿道损伤。手术时间40~150min;术中失血50~180ml。术后24~48h撤除导尿管,均自解小便。术后12~24h恢复正常饮食,生活自理。术后患者均无出血量P>50ml,无切口感染,术后3d血β-HCG值均下降明显(P>20%),7~24d血β-HCG值降至正常。结论剖宫产术后子宫瘢痕妊娠经阴切除病灶术为一种全新的微创的CSP治疗方案,损伤小、恢复快、无瘢痕;住院时间短、医疗费用低;麻醉要求简单、手术方法易掌握;不需要昂贵的手术器械;可谓是价廉又超微创的妇科手术。     

剖宫产瘢痕妊娠治疗方式的选择

剖宫产瘢痕妊娠是指受精卵种植于剖宫产后子宫瘢痕处的妊娠,是一种特殊的异位妊娠。随着“二胎政策”的开放、瘢痕子宫妊娠率的增加及阴道超声技术水平的提高,瘢痕妊娠的诊断率也逐渐提高。剖宫产瘢痕妊娠较为凶险,若不及时终止妊娠,可能会引起大出血、休克甚至危及生命。目前对于剖宫产瘢痕妊娠的治疗方式较多,但尚无统一的治疗标准。在选择治疗方式时应根据患者的情况权衡利弊。本文对瘢痕妊娠治疗方式的选择进行分析总结,旨在为瘢痕妊娠提供诊疗思路。     

瘢痕子宫妊娠患者在剖宫产术中大出血的临床分析

目的分析临床上子宫瘢痕妊娠患者在进行剖宫产术中出现大出血的具体情况,并采用有效的措施进行治疗。方法选取2011年4月~2013年10月收治的23例瘢痕子宫剖宫产术中大出血患者作为本次研究的观察对象,分别采取宫缩剂、持续性子宫按摩或按压等保守措施进行治疗,而对于无法止血的患者,则采取改良式B-Lynch缝扎术进行有效治疗,观察患者的治疗效果。结果本次研究中,保守治疗有4例,止血成功,但患者有长期腹部疼痛症状,改良式B-Lynch缝扎术治疗有19例,止血成功,且无死亡病例,患者恢复良好,效果最为明显。结论瘢痕子宫妊娠患者在进行剖宫产术中出现大出血情况是十分危险的,必须进行紧急处理,而改良式B-Lynch缝扎术操作简单,且可立即控制宫体部的凶猛出血,它不仅能快速止血,还能最大限度保全患者的子宫及其功能,对患者创伤小,止血效果明显,可作为基层医院治疗瘢痕子宫妊娠患者剖宫产术中大出血症状的首选治疗方式。     

米非司酮联合手术治疗剖宫产术后子宫瘢痕妊娠患者的临床价值分析

目的分析米非司酮联合手术治疗剖宫产术后子宫瘢痕妊娠患者的临床价值。方法选择2016年2月至2017年12月于我院就诊治疗的102例剖宫产术后子宫瘢痕妊娠患者作为研究对象,按不同治疗方式分为对照组(手术治疗)与观察组(米非司酮联合手术治疗),每组各51例。回顾性分析患者临床资料,比较两组患者治疗效果。结果观察组患者治疗后临床总有效率显著高于对照组(P0.05);观察组患者手术时间、术中出血量、阴道流血、住院时间、β-HCG恢复正常所需时间均显著少于或短于对照组(P0.05);观察组患者并发症总发生率明显低于对照组(P0.05)。结论剖宫产术后子宫瘢痕妊娠患者术前采取米非司酮药物干预可提高临床疗效,减少并发症,具有较高安全性,改善患者预后。     

子宫动脉栓塞介入治疗对剖宫产瘢痕妊娠患者止血及预后的影响

目的 探讨子宫动脉栓塞(UAE)介入治疗对剖宫产瘢痕妊娠(CSP)患者止血及预后的影响.方法 回顾性分析2012年7月至2017年7月期间本院收治的60例CSP患者临床资料,按照治疗方案分为A组(甲氨蝶呤+米非司酮预处理,29例)、B组(UAE预处理,31例).比较两组治疗相关指标、不良反应发生情况、治疗成功率及术后随...     

米非司酮预处理对剖宫产术后子宫瘢痕妊娠的疗效

目的:探究米非司酮预处理在剖宫产术后子宫瘢痕妊娠手术患者中的应用效果.方法:选取我院2018年5月至2020年7月期间74例剖宫产术后子宫瘢痕妊娠患者,随机分为对照组和研究组(n=37),其中对照组患者接受宫腔镜联合阴式病灶切除手术治疗,研究组患者则于术前3 d开始连续3 d口服米非司酮片25 mg Bid.术中及术后...     

子宫动脉栓塞术在子宫疤痕部位妊娠的应用

目的 探讨子宫动脉栓塞术在治疗子宫疤痕部位妊娠的应用价值.方法 回顾性分析16例剖宫产术后子宫疤痕部位妊娠患者的临床资料.有7例在行双侧子宫动脉栓塞术后4～5 d再行清宫术;9例直接行清宫术或剖腹探查术.给果 7例行双侧子宫动脉栓塞术患者手术均一次成功,术中术后出血少,恢复快;9例行清宫术或剖腹探查术,术中术后出血多,恢复慢.结论 子宫疤痕部位妊娠患者经子宫动脉栓塞术预处理后,手术的出血及风险可明显减少,成功率高.     

Conservative treatment by angiographic uterine artery embolization of a 12 week cervical ectopic pregnancy

A 32 year old woman, gravid 1, nulliparous, was admitted to our department at 11 weeks and 2 days of gestation after being diagnosed with cervical pregnancy. She was unsuccessfully treated with methotrexate for 5 days. On the fifth day after admission she underwent bilateral uterine artery angiographic embolization followed by vacuum evacuation and curettage of the cervical canal. A Foley catheter was also inserted in the cervical canal and left in place for 4 days. The patient was discharged in good condition on the seventh postoperative day.     

子宫疤痕妊娠处注射MTX联合宫腔镜电切在子宫瘢痕妊娠治疗中的应用

孕卵着床于子宫剖宫产瘢痕者,称为子宫剖宫产瘢痕妊娠(caesarean scar pregnancy,CSP),是一种少见而又危险的异位妊娠,如盲目清宫,常常发生不易控制的大出血[1].南方医科大学附属小榄医院选择病情稳定的早期病例,应用B超监视下子宫疤痕妊娠部位注射MTX联合宫腔镜电切清除妊娠组织成功治疗CSP 18例,现报道如下.     

阴道彩超及MRI诊断剖宫产术后子宫疤痕妊娠的临床价值

目的 探讨阴道彩超及MRI对剖宫产术后子宫疤痕妊娠的诊断价值.方法 回顾性分析经手术病理及临床证实的20例剖宫产术后子宫疤痕妊娠的临床资料,20例行阴道彩超,17例1周内行MRI检查.结果 20例中,阴道彩超诊断正确15例（75％）,误诊5例（25％）,阴道彩超诊断准确率为75％.阴道彩超分为两型：单纯妊娠囊型14例（70％）;混合回声包块型6例（30％）.MRI分为两型：单纯妊娠囊型：9例（约52.9％）;混杂团块型：8例（约47.1％）,17例MR检查均正确诊断.结论 剖宫产术后子宫疤痕妊娠的主要影像学表现为子宫疤痕处的囊性、囊实性结节或肿块.阴道彩超及MRI均可作出准确诊断,MRI在诊断子宫疤痕妊娠方面优于阴道彩超,可作为子宫疤痕妊娠的重要补充.     

Uterine artery embolization for management of interstitial twin ectopic pregnancy: case report

Interstitial pregnancy is rare and dangerous variation of ectopic pregnancy. We describe a case of unilateral interstitial viable twin pregnancy treated by selective uterine artery embolization. A 23-year-old women with clinical and ultrasonic diagnosis of viable twin interstitial pregnancy was treated by selective uterine artery embolization after failure of systemic methotrexate treatment. Her serum beta-HCG was undetectable 2 months after the procedure and the ultrasound scan 70 days after embolization showed only multiple echogenic spots in the right uterine cornua. This therapeutic modality seems to be effective for conservative management of interstitial ectopic pregnancy, and as a prophylactic measure before surgical intervention to prevent major bleeding.     

Laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar.

A case of laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar is reported. A 30 year old woman was admitted to our hospital for profuse vaginal bleeding 2 weeks after an abortion had been performed. A urine pregnancy test was positive. Abdominal ultrasound revealed a well-encapsulated bulging mass over the lower anterior uterine wall measuring 7x5 cm. Hysteroscopy revealed retained gestational tissue in the lower corpus despite a normal uterine cavity. An incision was made over the most prominent area of the mass by operative laparoscopy. Dark reddish tissue suggestive of the products of conception was removed using grasping forceps. One-layer of continuous endoscopic sutures along the affected uterine wall was made with 1-0 Prolene. Laparoscopy enabled the successful treatment of an unruptured ectopic pregnancy in a previous Caesarean scar and made it possible to preserve the patient's reproductive capability.     

Fine-needle aspiration cytodiagnosis of endometriosis in cesarean section scar and rectus sheath mass lesions -- a study of seven cases

The diagnosis of endometriosis is usually established by a biopsy. Since endometriotic lesions can present as a mass lesion, it seems feasible to investigate them by the noninvasive method of fine-needle aspiration cytology (FNAC). In this study, seven cases (5 from a cesarean scar and 2 from rectus sheath) are presented in which FNAC was indicative of endometriosis. The aspirate was obtained using a disposable 10 ml syringe and 22 gauge needle. The material was collected as syringe and needle washings in a cytology container in which 30% ethyl alcohol was present. From half of this material, filter preparations were made on size 3 mum filters and stained by Papanicolaou method, while the remaining aspirate was spun and a cell block was made from the sediment and sections cut and stained with hematoxylin-eosin stain. In all cases the cytologic preparations showed tubular structures indicative of endometrial tissue and stromal cells indicative of endometriosis. This was further confirmed on examination of cell blocks, which showed histologic features of endometriosis characterized by endometrial glands separated by endometrial stroma and rare siderophages. The seven cases described are interesting, since the cytohistological finding in FNAC sample and cell block not only were indicative of the diagnosis of endometriosis, but also obviated the need for an invasive surgical procedure.