CAJ | 학술논문

探讨Foley导尿管球囊宫内置入配伍卡孕栓治疗子宫瘢痕妊娠刮宫时大出血的疗效及可行性。收集2000年1月~2014年12月我院收治的确诊为剖宫产术后子宫瘢痕妊娠且在刮宫中出现大出血9例患者的临床资料，在刮宫大出血时采用Foley导尿管球囊宫内置入配伍卡孕栓进行治疗，统计分析止血效果、术后阴道流血时间、月经恢复情况。7例经Foley导尿管球囊压迫和卡孕栓止血，24~48 h拔出后，均无再次出血，血绒毛膜促性腺激素(β-HCG)术后15 d正常，30~45 d月经复潮；月经复潮后再次B超检查均未发现宫腔内异常。1例在拔出尿管后出现持续少量阴道出血，β-HCG术后15 d未降至正常，B超提示子宫切口有残留，给予药物治疗失败，因再次出血行宫腔镜下清宫术，未再出血。另1例拔出尿管后次日再次大出血，致轻度失血性休克，强烈要求行子宫次全切除术。Foley导尿管球囊宫内置入配伍卡孕栓治疗是瘢痕妊娠刮宫时大出血的有效辅助治疗手段，疗效确切，无子宫内膜损伤，值得推广。
탐토Foley도뇨관구낭궁내치입배오잡잉전치료자궁반흔임신괄궁시대출혈적료효급가행성。수집2000년1월~2014년12월아원수치적학진위부궁산술후자궁반흔임신차재괄궁중출현대출혈9례환자적림상자료，재괄궁대출혈시채용Foley도뇨관구낭궁내치입배오잡잉전진행치료，통계분석지혈효과、술후음도류혈시간、월경회복정황。7례경Foley도뇨관구낭압박화잡잉전지혈，24~48 h발출후，균무재차출혈，혈융모막촉성선격소(β-HCG)술후15 d정상，30~45 d월경복조；월경복조후재차B초검사균미발현궁강내이상。1례재발출뇨관후출현지속소량음도출혈，β-HCG술후15 d미강지정상，B초제시자궁절구유잔류，급여약물치료실패，인재차출혈행궁강경하청궁술，미재출혈。령1례발출뇨관후차일재차대출혈，치경도실혈성휴극，강렬요구행자궁차전절제술。Foley도뇨관구낭궁내치입배오잡잉전치료시반흔임신괄궁시대출혈적유효보조치료수단，료효학절，무자궁내막손상，치득추엄。
To explore the curative effect and feasibility of intrauterine implantation of Foley catheter balloon combined with carboprost suppositories in treatment of hemorrhea during uterine scar pregnancy curettage. The clinical data of nine patients who received treatment in our hospital from January 2000 to December 2014 were collected, and the patients were definitely diagnosed with post-cesarean uterine scar pregnancies and were confronted with hemorrhea during uterine curettage. When hemorrhea occurred during uterine curettage, they received the intrauterine implantation of Foley catheter balloon combined with carboprost suppositories. The hemostatic effect, post-operation vaginal bleeding times and menstruation resumption status were summarized and analyzed. Foley catheter balloons and carboprost suppositories were used for hemostasis and the catheters were pulled out after 24-48 hours. Seven patients suffered no re-bleeding after the catheters were pulled out; their β-HCG became normal 15 days after operation and the menstruation resumed 30-45 days after operation;no intrauterine abnormality was found in the B-type ultrasonic reexamination after the menstruation resumption. One patient suffered a continuous light vaginal bleeding after the catheter was pulled out; her β-HCG did not reduce to the normal value 15 days after operation; some uterus incision residues were found in the B-type ultrasonic reexamination and then she received the drug therapy but the treatment failed; due to re-bleeding, she received complete hysteroscopic uterine curettage again and then bleeding occurred no longer. Another patient suffered hemorrhea again just one day after the catheter was pulled out and fell in a mild hamorrhagic shock, and then she strongly urged for the subtotal hysterectomy. The intrauterine implantation of Foley catheter balloon combined with carboprost suppositories is an effective adjuvant therapy in treatment of hemorrhea during uterine scar pregnancy curettage. It achieves a definite curative effect and causes no injure to the endometrium, so it is worthy of a wider application.