CAJ | 학술논문

目的：探讨足月宫角妊娠的高危因素，产前如何识别与处理足月宫角妊娠，避免产科严重并发症的发生。方法2006年1月～2012年8月在我院分娩的孕妇3798例。对其中经剖宫产或剖腹探查术中明确诊断足月宫角妊娠的5例病例，及外院2005年5月1例足月宫角妊娠病例共6例病例进行回顾性分析。结果6例发生胎盘滞留，而且均发生在右侧子宫角部，4例以剖宫产结束分娩，1例阴道分娩后切除子宫；另1例阴道分娩后因胎盘滞留行剖宫产手术。5例产前或产后超声提示：胎盘位于子宫底后壁或右侧宫角；4例有人工流产史；2例阴道分娩后发生产后出血。结论足月宫角妊娠高危因素可能与人工流产手术导致的子宫内膜损伤有关，分娩最主要的并发症主要以胎盘滞留为首要并发症，多数以手术结束分娩。因此，产前及时识别宫角妊娠，选择合理的分娩方式，可以减少某些足月宫角妊娠并发症的发生，尽量保留患者的生育功能。
목적：탐토족월궁각임신적고위인소，산전여하식별여처리족월궁각임신，피면산과엄중병발증적발생。방법2006년1월～2012년8월재아원분면적잉부3798례。대기중경부궁산혹부복탐사술중명학진단족월궁각임신적5례병례，급외원2005년5월1례족월궁각임신병례공6례병례진행회고성분석。결과6례발생태반체류，이차균발생재우측자궁각부，4례이부궁산결속분면，1례음도분면후절제자궁；령1례음도분면후인태반체류행부궁산수술。5례산전혹산후초성제시：태반위우자궁저후벽혹우측궁각；4례유인공유산사；2례음도분면후발생산후출혈。결론족월궁각임신고위인소가능여인공유산수술도치적자궁내막손상유관，분면최주요적병발증주요이태반체류위수요병발증，다수이수술결속분면。인차，산전급시식별궁각임신，선택합리적분면방식，가이감소모사족월궁각임신병발증적발생，진량보류환자적생육공능。
Objective To discuss the high risk factors of full-term angular pregnancy, as well as how to recognize and deal with full-term angular pregnancy, so as to avoid severe complications of antepartum period. Methods 3798 cases of pregnant women finished childbirth in our hospital from January 1st, 2006 to August 30th, 2012. We launched a retrospective analysis on the 6 women who had full-term angular pregnancy diagnosed by cesarean delivery or abdominal laparotomy,of which 5 are patients in our own hospital and 1 from another hospital. Results 6 of the patients had mazischesis, who all had angular pregnancy on the right uterine horn. 4 of them finished childbirth with cesarean delivery, and 1 of them accepted hysterectomy after vaginal delivery, other 1 of them accepted exploratory laparotomy after vaginal delivery, becase mazischesis. The placentas of 5 patients were at fundus uteri paries posterior or dextral cornu uteri showed by ultrasound. 4 patients had induced abortion history. 2 patients suffered postpartum hemorrhage after vaginal delivery. Conclusion The high risk of full-term angular pregnancy may include endometria injury caused by artificial abortion operation. The main complication of full-term angular pregnancy during parturition is mazischesis, and most of them finish childbirth by surgery. Therefore, timely diagnosis of comual pregnancy and appropriate delivery mode can reduce the incidence of complication of angular pregnancy and may well keep the fertility ability of patients.