妊娠晚期瘢痕子宫不全破裂的临床分析.pdfVIP

278 华西医学 20 10 , 25 (2) 　W e st Ch ina M edical Jou rnal, Vol. 25,No. 2 Feb. 20 10 论 　著 妊娠晚期瘢痕子宫不全破裂的临床分析 蔡瑞贤 ,戴婉波 ,覃小红 ,黄丽萍 ,黄珍 【摘要 】　目的　探讨瘢痕子宫不全破裂的早期诊断、处理及预防 。方法 　2006 年 1月 - 2009 年 1月发生瘢痕 子宫不全破裂 13例 ,术前临床症状加 B 超检查确诊 ,手术从原切 口进入宫腔 ,取出胎儿 ,修剪原切 口周围瘢痕组织 , 10可吸收线连续缝合浆肌层 ,再间断包埋缝合切 口,术后常规预防感染 ,加强宫缩治疗 ;胎盘植入 2 例尽量取出胎 盘 ,修整切口,活动性出血明显者用 10可吸收线 “8 ”字缝扎止血 ,术后加服米非司酮 150 m g/ d共 3 d。结果 　母婴均 痊愈出院。42 d后来院复查 , B 超探查 8例子宫下段处有线状较强回声 ,肌层回声均匀 ,余未发现异常 ;胎盘植入 2 例 ,随防 3个月血绒毛膜促性腺激素呈阴性 。结论 　早期 B 超检查能提高瘢痕子宫不全破裂确诊率 ,确诊后急诊剖 宫产 ,胎盘部分植入者加服米非司酮并预防感染 。 【关键词 】　妊娠晚期 ;瘢痕子宫 ;不全破裂 ;胎盘植入 ;治疗 【中图分类号 】　R7 14. 2　　【文献标志码 】　A In com plete Uter ine Scar Rupture in L a te Pregnancy : C lin ica l Ana ly sis of 13 Ca ses　CA I R u ix ian, DA I W anbo, Q IN X iaohong, HUAN G L ip ing, HUAN G Z hen. The D ep a rtm en t of O bs tetrics, S henzhen S haj ing H osp ita l, Guangzhou M ed ica l Colleg e, S henzhen, Guang dong 518104, P. R. Ch ina 【A b stract】　O bjective 　 To exp lore the early diagno sis, treatm en t and p revention of the incomp lete u terine scar rup ture. M ethods　From J anuary 2006 to January 2009, 13 p atien ts w ith incomp lete u terine scar rup tu re were studied. The p reop erative diagno sis was m ade according to the clin ical symp tom s p lu s B u ltrasonography. Surgical incision into the u terine cavity wa s p erform ed from the original incision site, the fetu s was removed ou t, the surrounding scar tissue of the original incision wa s p runed, the p u lp m u scle layer was sewed up continuou sly w ith a 10 ab sorbab le suture, and then the incision wa s em bedded and sewed up by the in terrup ted suture. The infection wa s p reven ted rou tinely after strengthen ing the u ter