CAJ | 학술논문

目的：探讨剖宫产术后子宫瘢痕部妊娠的诊治情况。方法：2011年10月-2014年10月收治剖宫产瘢痕部妊娠患者18例。18例患者既往剖宫产术式均为子宫下段横切口，均有停经史及阴道流血。3例肌注甲氨蝶呤治疗加清宫术，其中2例保守治疗成功，其中1例因突发大量阴道流血而中转开腹手术行子宫切除术。6例先肌注甲氨蝶呤后行宫腔镜下瘢痕妊娠病灶电切术，其中5例治疗成功，1例因宫腔镜手术突发大量阴道流血中转子宫动脉栓塞术后再行宫腔镜下瘢痕妊娠病灶电切术。9例先行子宫动脉栓塞术后肌注甲氨蝶呤，再行宫腔镜下瘢痕妊娠病灶电切术。结果：18例患者术后28～56 d血HCG均降至正常范围以下，除1例子宫切除的患者，其余17例患者于术后2～5个月月经来潮，术后2～4个月子宫下段瘢痕部包块完全吸收。结论：剖宫产术后的育龄期女性再次妊娠时有发生瘢痕妊娠的可能，子宫动脉栓塞术联合宫腔镜下剖宫产瘢痕部妊娠病灶电切术在治疗瘢痕妊娠时具有更大的优势。
목적：탐토부궁산술후자궁반흔부임신적진치정황。방법：2011년10월-2014년10월수치부궁산반흔부임신환자18례。18례환자기왕부궁산술식균위자궁하단횡절구，균유정경사급음도류혈。3례기주갑안접령치료가청궁술，기중2례보수치료성공，기중1례인돌발대량음도류혈이중전개복수술행자궁절제술。6례선기주갑안접령후행궁강경하반흔임신병조전절술，기중5례치료성공，1례인궁강경수술돌발대량음도류혈중전자궁동맥전새술후재행궁강경하반흔임신병조전절술。9례선행자궁동맥전새술후기주갑안접령，재행궁강경하반흔임신병조전절술。결과：18례환자술후28～56 d혈HCG균강지정상범위이하，제1례자궁절제적환자，기여17례환자우술후2～5개월월경래조，술후2～4개월자궁하단반흔부포괴완전흡수。결론：부궁산술후적육령기녀성재차임신시유발생반흔임신적가능，자궁동맥전새술연합궁강경하부궁산반흔부임신병조전절술재치료반흔임신시구유경대적우세。
Objective:To investigate the diagnosis and treatment of uterine scar pregnancy after cesarean section.Methods:18 patients with cesarean scar pregnancy were selected from October 2011 to October 2014.Previous cesarean section of 18 patients were all transverse incision of lower uterine segment,who had the menopause history and vaginal bleeding.3 cases were given intramuscular injection of methotrexate treatment with curettage,among them,2 cases of conservative treatment were successful,1 case was converted to open operation for hysterectomy due to a sudden and massive vaginal bleeding.6 cases were treated with hysteroscopic electric resection of scar pregnancy lesions after intramuscular injection of methotrexate,of which 5 cases of the treatment were successful,and 1 case was converted to uterine artery embolization because of sudden and massive vaginal bleeding in hysteroscopic surgery,who was again treated with hysteroscopic electric resection of scar pregnancy lesions.9 cases were given intramuscular injection of methotrexate after uterine artery embolization,and then were treated with hysteroscopic electric resection of scar pregnancy lesions. Results:Blood HCG of 18 cases were dropped below the normal range postoperative 28~56 d.In addition to 1 case of hysterectomy,the remaining 17 cases menses in 2~5 months.Masses in lower uterine segment scar were completely absorbed after 2~4 months.Conclusion:Scar pregnancy is possible in repregnancy of women of childbearing age after cesarean section.Uterine artery embolization combined with pregnancy lesions electrotomy at cesarean section scar under hysteroscope has more advantages in the treatment of scar pregnancy.