摘要
目的:探讨瘢痕子宫妊娠(CSP)人工流产术后大出血的防治方法及临床预后。方法:回顾分析2010年1月-2018年5月本院收治的CSP术后出血患者102例临床资料,分析临床治疗方法及预后。结果:①102例患者中,大出血36例,少量出血66例,两组孕周、孕周>8周比例、宫腔包块直径及包块直径>60 mm比例、子宫瘢痕肌层厚度比较有差异(P<0.05),logistic回归分析显示孕周>8周及包块直径>60 mm是大出血发生的独立危险因素。②36例大出血患者,子宫次全(全)切除3例,宫腔填塞止血5例,紧急子宫动脉栓塞(UAE)止血28例,其中单纯UAE 5例、UAE+甲氨蝶呤(MTX)等药物8例,UAE+宫腔镜或超声引导下清宫术8例,UAE+经腹瘢痕妊娠物清除修补术7例;66例少量出血中,药物保守治疗[MTX+(米非司酮)MF]31例,手术治疗35例(宫腔镜或超声引导下清宫术19例,经腹瘢痕妊娠物清除修补术16例)。③患者均止血成功,手术治疗的止血速度及康复速度较保守治疗更快。结论:具有剖宫产史者再次妊娠行人工流产术后大出血应警惕CSP,采用UAE可紧急控制阴道大出血,必要时可辅助药物治疗,也可采取保守手术或清除修补术补充治疗。
Objective:To investigate the prevention and treatment methods for treating massive bleeding of women with caesarean scar pregnancy(CSP)during or after abortion,and to analyze their prognosis.Methods:The clinical data of 102 women with CSP who had bleeding during or after abortion from January 2010 to May 2018 were analyzed retrospectively.And the clinical treatment methods and prognosis of these included women were analyzed.Results:In the 102 women,36 women with massive bleeding were in group A,and 66 women with less amount bleeding were in group B.The gestational weeks,the proportion of more than 8 gestational weeks,the proportion of uterine diameter or mass diameter>60 mm,and uterine scar thickness of women had significant different between the two groups(P<0.05).Logistic regression analysis showed more than gestational weeks and mass diameter>60 mm were independent risk factors for massive bleeding.In group A,3 women had experinced total or subtotal hysterectomy for treating bleeding,5 women had experinced uterine cavity tamponade,and 25 women had experinced uterine artery embolization(UAE)(5 women treated by UAE only,8 women treated by UAE combined with MTX,8 women treated by UAE combined with curettage through hysteroscopy or ultrasound guidance,7 women treated by UAE combined with transabdominal scar pregnancy clearance and repair).In group B,31 women treated by conservative treatment(MTX combined with MF),35 women treated by surgery(19 women treated by curettage through hysteroscopy or ultrasound guidance,and 16 women treated by transabdominal scar pregnancy clearance and repair).All women had hemostasis successfully,and the hemostasis time and recovery time of women treated by surgical were shorter than those of women by conservative treatment.Conclusion:Women with history cesarean section should beware CSP and massive bleeding after abortion.UAE used for hemostasis can emergency treating vaginal bleeding effectively,and drug combination therapy is necessary.Conservative surgery or transabdominal scar pregnancy clearance and repair is also as a complementary treatment method.
作者
姜家英
刘红
JIANG Jiaying;LIU Hong(Ankang Hospital of Traditional Chinese Medicine,Shanxi Province,725000)
出处
《中国计划生育学杂志》
2019年第11期1517-1521,共5页
Chinese Journal of Family Planning
关键词
瘢痕子宫妊娠
人工流产术
大出血
子宫动脉栓塞
Caesarean scar pregnancy
Abortion
Homorrhoea
Uterine artery embolization
