林美琼

[摘要] 目的 對不同类型的剖宫产术后子宫瘢痕妊娠的临床特点进行分析总结，同时找到相应的处理方法，以达到最佳的临床效果。方法 方便选取该院2010年1月—2016年12月就诊的46例剖宫产术后子宫瘢痕妊娠患者的病例特点（停经天数、B超下妊娠囊大小、是否心管闪动及妊娠囊种植处子宫疤痕肌层最薄处厚度及分型、血HCG值、转归）进行回顾性分析，根据它们的特点，对它们进行临床分型，分析各种类型不同的处理方法，以及相应的临床效果，最后再进行总结，得出一套较为完整的相关个体化的处理方法。结果 对该院7年间就诊的46例患者，按临床情况进行分类及实施不同治疗方案： 2例药物流产、6例药物+清宫、29例子宫动脉栓塞后清宫、7例开腹行子宫疤痕妊娠病灶切除、1例子宫切除等，除个别因病情特殊，都达到理想的临床效果。结论 通过对临床实例的研究，充分了解了此类病例可以根据每个病例不同的临床特点，再采取个体化的原则酌情进行相关的治疗，达到了基本满意的临床效果，最后对这些结果进行分析总结，得出整套该类病例的系统性的处理经验，希望此经验在临床上加以推广。

[关键词] 剖宫产术；疤痕妊娠；分类；临床特点；处理

[中图分类号] R714 [文献标识码] A [文章编号] 1674-0742（2017）09（b）-0084-03

[Abstract] Objective This paper tries to analyze and summarize the clinical characteristics of different types of cesarean scar pregnancy after cesarean section and to find out the corresponding treatment methods to achieve the best clinical effects. Methods The cases characteristics （days of menopause， the size of gestational sac by B-ultrasonography， cardiac tube flashing， the thinnest thickness and the types of the scar muscularis at the implantation site of the gestational sac， the serum levels of HCG， and prognosis） of the 46 cases of patients with cesarean scar pregnancy after cesarean section in this hospital from January 2010 to December 2016 were retrospectively analyzed； on the basis of these， their clinical types were classified， various types of different treatment methods and the corresponding clinical effects were analyzed， and a set of relatively complete individualized treatment methods of such pregnancy were summarized. Results Those 46 cases during these 7 years were classified by different the clinical types and different treatment options： 2 cases of drug abortion， 6 cases of drug abortion merged with curettage， 29 cases of curettage after uterine artery embolism， 7 cases of laparotomy for uterine scar pregnancy lesion resection， 1 case of hysterectomy and so on， the presumptive ideal clinical effects were achieved in addition to a few exceptions of special conditions. Conclusion Through the study of clinical examples， it can be thoroughly understood that these cases can take the individual principles of discretionary treatment based on different clinical features， and then， to achieve basic satisfactory clinical results， and finally the results will be analyzed and concluded. The complete set of systematic treatment experience can be obtained， and this experience is hoped to be promoted in the clinical practice.

[Key words] Cesarean section； Scar pregnancy； Classification； Clinical characteristics； Treatmentendprint

随着现代人们生活水平的不断提高，人们对分娩疼痛的耐受能力反而下降，因医疗水平的不断发展，产科剖宫产的水平趋于成熟，加上若干年来的独生政策，很大一部分人依赖剖宫产来避开传统的阴道分娩可能带来的疼痛与风险，所以一度曾出现全国各地剖宫产率居高不下；……