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双语推荐：瘢痕子宫

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目的：对比分析剖宫产在瘢痕子宫和非瘢痕子宫中的临床应用效果。方法：选取2012年2月至2013年11月在我院妇产科进行剖宫产分娩的瘢痕子宫和非瘢痕子宫的产妇68例，分析探究其手术相关的临床资料，比较剖宫产在两种性质子宫产妇中的应用。结果：进行剖宫产分娩的产妇的临床资料中，瘢痕性子宫产妇的年龄明显比非瘢痕组产妇大，并且瘢痕性子宫产妇在手术过程中的出血量以及手术时长也明显大于非瘢痕性子宫产妇，术后腹腔粘连情况也重于非瘢痕性子宫产妇，其差异具有统计意义（P ＜0.05）；两组产妇分娩出的新生儿在出生时的体重以及1min、5min的 Apgar 评分均无显著差异（P ＞0.05）。结论：瘢痕子宫在剖宫产手术中的风险系数明显高于非瘢痕子宫，因此在瘢痕子宫产妇的分娩中需要更加注意手术中的相应风险因子，保证产妇顺利分娩。
Objective:To analysis of cesarean section in the clinical application effect of scar uterus and no scar in the womb.Methods:Between February 2012 in November 2013 in obstetrics and gynecology hospital cesarean section delivery of scar and the scar uterus,68 cases of maternal uterine and related clini-cal data analysis to explore the surgery,comparison of cesarean section in the application of the nature of the two kinds of maternal womb.Results:The clinical data of cesarean section delivery of maternal,cicatricial uterus obviously than the scar group maternal maternal age is big,and cicatricial uterus maternal blood loss in the operation process and operation is also significantly greater than the cicatricial uterus,maternal postoperative abdomen al adhesion is also focuses on the cicatricial uterus maternal,the difference has statistical significance (P 0.05).Conclusion:Scar uterus in the coefficient is significantly higher than the risk of scar uterine cesarean section surg

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目的探讨剖宫产宫壁瘢痕缺损的B超诊断。方法回顾性分析B超诊断剖宫产宫壁瘢痕缺损的结果及参数特点。结果本组共检出剖宫产宫壁瘢痕缺损57例,检出率为63.33%;剖宫产宫壁瘢痕缺损组经产妇瘢痕至宫颈内口距离及前位子宫率均明显低于剖宫产宫壁瘢痕完整组,差异具有统计学意义（P〈0.05或P〈0.01）;两组经产妇子宫内膜厚度、优势卵泡的直径、子宫长径、子宫前后径和子宫横径比较,差异无统计学意义（P〉0.05）;不同剖宫产次数及子宫前后位置宫壁瘢痕缺损参数相互比较,差异无统计学意义（P〉0.05）。结论剖宫产宫壁瘢痕缺损临床检出率较高,位置多接近于宫颈内口,子宫后位者发生剖宫产宫壁瘢痕缺损风险更高。
Objective To discuss diagnosis of post-caesarean section scar defect(PCSD)by B ultrasonography. Methods A retrospective analysis was conducted on the results and parameter characteristics of PCSD diagnosis by B ultrasonography. Results 57 cases of PCSD were detected with detection rate of 63.33%. The group with PCSD had significantly shorter distance between the scar and the internal cervix and significantly lower incidence of anteposition of uterus than the group with post-caesarean section intact scar, with statistical significance (P 0.05). There was no statistical difference regarding the number of caesarean sections and the parameters of post-caesarean section scar defect at anterior and posterior uterus (P>0.05). Conclusion PCSD has high detection rate in clinical practice and PCSD is often adjacent to the internal cervix. Patients with retroposition of uterus have higher risk of PCSD.

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探讨瘢痕子宫与胎盘植入两者之间的关系,总结临床治疗瘢痕子宫伴胎盘植入的方案与效果。方法:选取本院25例瘢痕子宫伴胎盘植入的孕妇,回顾分析孕妇临床资料,观察治疗效果,总结瘢痕子宫和胎盘植入两者之间的关系。结果:25例胎盘植入患者均有行剖宫产史,表现有瘢痕子宫症状,出现率为100%,由此证实两者之间具有典型的相关性关系。25例孕妇当中,行介入治疗者8例,行子宫次全切术者4例,行子宫修补与部分切除者2例,行保守治疗者11例,子宫切除率为24.00%(6/25),未出现死亡患者。结论:产妇既往时期行剖宫产后,子宫切口处的瘢痕未完全愈合,形成瘢痕子宫,使胎盘绒毛等侵入到肌层或浆膜层,是诱发胎盘植入病症的主要原因。临床医师应根据孕妇情况,选择介入、切除手术或者保守方案施治,均有一定疗效。
Objective:To explore the relationship between the scar uterus and placenta accreta,summarize the clinical treatment and results of uterine scar with placenta accreta programs.Method:25 uterine scar pregnant women with placenta accreta in our hospital were selected,therapeutic effects were observed,the relationship between the scar uterus and placenta accreta were summarized.Result:25 placenta accreta patients had history of cesarean section,showing a scar on the uterus symptoms,the probability was 100%,confirmed closer relationship between the two diseases.Among 25 pregnant women,interventional therapy in 8 cases,hysterectomy subtotal resection in 4 cases,uterine repair and partial resection in 2 cases,conservative treatment in 11 cases,hysterectomy rate was 24.00%(6/25),no deaths occurred in patients.Conclusion:Cesarean section after maternal uterine incision scar is not completely healed,the formation of scar uterus,placenta or the like into the muscular layer or serosa,is induced by

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总结剖宫产后子宫瘢痕处妊娠(CSP)的临床特点与处理体会。方法:对48例剖宫产术后子宫瘢痕处妊娠患者的临床资料进行回顾性分析。结果:2例患者进行了子宫次全切术,17例患者进行了子宫瘢痕处超声引导下甲氨蝶呤治疗,21例患者进行了腹腔镜瘢痕处的组织切除术或瘢痕修补术,5例患者进行了超声引导下的清宫术,另外3例患者运用子宫动脉栓塞术联合甲氨蝶呤的方式进行治疗。结论:剖宫产术后子宫瘢痕处妊娠是较为少见的妇科症状,应及早诊断,以便制定和采用个性化的联合治疗方案。
Objective:To summarize clinical characteristics and treatment of cesarean scar pregnancy(CSP). Methods:The clinical data of 48 cases with CSP were retrospectively analyzed. Results:2 cases were suffered from subtotal hysterectomy,17 cases had a uterine scar ultrasound guided methotrexate therapy,21 cases were under laparoscopic scar tissue excision or scar repair,5 cases received ultrasound guided complete curettage of uterine cavity,and the other 3 cases were treated by uterine artery embolization com-bined with methotrexate. Conclusions:The cesarean scar pregnancy after cesarean section is a rare gynecologic symptom,and should be diagnosed early so as to formulate and apply a personalized combination therapy regimen.

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目的探讨瘢痕子宫(前次剖宫产史)对再次妊娠的分娩方式和结局的影响。方法回顾性分析2012-01至2014-03于北京军区总医院妇产科初诊建档、定期产检,并于该院分娩的瘢痕子宫妊娠病例322例(瘢痕组),随机抽取同期非瘢痕子宫妊娠病例328例(非瘢痕组),比较两组的分娩方式和妊娠结局。结果瘢痕组和非瘢痕组孕妇年龄、分娩孕周、孕次、产次、分娩前体重指数比较,差异均无统计学意义。瘢痕组剖宫产261例,占81.1%;非瘢痕组剖宫产173例,占52.7%;两组差异有统计学意义(χ2=58.70,P0.01)。瘢痕组的前置胎盘、胎盘粘连(植入)的发生率为13.7%、9.0%,均高于非瘢痕组的0.9%、0.6%(χ2分别为39.38、25.22,P均0.01);而瘢痕组和非瘢痕组的胎盘早剥发生率比较,差异无统计学意义(χ2=2.76,P0.05)。瘢痕组子宫破裂(1.6%)、产后出血(10.9%)、产褥发热(11.5%)等发生率均高于非瘢痕组(分别是0、2.7%和5.5%),差异有统计学意义(χ2分别为5.13、17.00、7.56,P均0.01)。结论瘢痕子宫妊娠的并发症发生率高于非瘢痕子宫妊娠,其前置胎盘、胎盘粘连(植入)、产后出血的风险性明显升高。瘢痕子宫孕妇再次妊娠的分娩方式仍以剖宫产为主。
Objective To study the influence of the uterine scar pregnancy on the ways of delivery and outcome.Methods A retrospective survey was conducted of the patients who had been admitted to the obestetrics department of this hospital, all of whom had been under rules of regular inspection and had given birth to baby in the same hospital.The total sample included 322 cases of u-terine scar pregnancy as the observation group, and 328 patients without uterine scar pregnancy as the control group by random.Com-parison was made between the two groups in the ways of delivery and outcome of pregnancy.Results The comparisons of average age, average week of delivery, mean gravidity, mean parity between the two groups did not show statistically significant differences.261 ca-ses (81.1%) underwent cesaran section in the observation group, 173 cases (52.7%) did so in the control group, with statistically significant difference between the two groups.The incidence rates of placenta praevia and

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目的：探讨瘢痕子宫再次妊娠分娩方式的选择和可行性，降低剖宫产率。方法对本院2011年1月～2013年12月瘢痕子宫再次妊娠的615例产妇临床资料进行回顾性分析，按分娩方式的不同分为再次剖宫产组536例，经阴道试产分娩组79例，并选取同期非瘢痕子宫经阴道试产产妇3470例与瘢痕子宫经阴道试产产妇117例及首次剖宫产的产妇2274例与再次剖宫产的产妇536例进行分析比较。结果再次剖宫产组和阴道分娩组在新生儿 Apgar 评分、体重方面比较差异均无统计学意义（P>0.05）；瘢痕子宫经阴道分娩产后出血发生率小于再次剖宫产产后出血率，具有显著差异（P＜0.05）；瘢痕子宫经阴道分娩成功率及顺产率均小于非瘢痕子宫阴道试产产妇，均具有显著差异（P＜0.05）；瘢痕子宫阴道试产的孕妇在侧切、产钳使用、产后出血方面与非瘢痕子宫阴道试产的孕妇比较，均无显著差异（P＞0.05）；再次剖宫产产妇在切口感染、介入、羊水栓塞方面与首次剖宫产产妇比较，均无显著差异（P＞0.05）；再次剖宫产产妇子宫切除率、产后出血率大于首次剖宫产产妇，均有显著差异（P＜0.05）。结论对瘢痕子宫再次妊娠分娩孕妇应进行综合评估，采取合适的分娩方式，另外需严格掌握首次剖宫产指征。
Objective To explore the option and feasibility of the uterine scar pregnancy again and reduce the rate of cesarean delivery. Methods A total of 615 cases of puerperal clinical patients in the hospital from January 2011 to De-cember 2013 were analyzed. According to the pregnancy type, cesarean section again included 536 cases and vaginal delivery included 79 cases. And 3470 cases of vaginal delivery were selected by compared 117 cases uterine scar vagi-nal delivery, plus 2274 cases of cesarean delivery for the first time were selected by compared 536 cases of cesarean section again. Results Cesarean section again group and vaginal delivery group in the Apgar score, weight, the differ-ence was not statistically significant(P>0.05); The postpartum hemorrhage rate in uterine scar vaginal delivery group were significantly smaller than the cesarean sections again group (P 0.05); Incision infection, interventional surgery and amniotic fluid embolism were no significantly be-tween c

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目的：：回顾性分析子宫瘢痕妊娠的超声声像图特征，探讨超声检测对瘢痕妊娠早期诊断的价值及临床意义。方法：回顾性分析本院收治的35例疑似子宫瘢痕妊娠患者的早期超声诊断资料，将早期超声诊断结果与手术病理证实结果进行对比分析，评估早期超声诊断效果。结果：35例疑似子宫瘢痕妊娠患者中，经超声探查有32例符合子宫瘢痕妊娠声像，超声诊断正确率为91.4%（32/35），超声早期诊断结果与手术证实结果间具有正相关性。结论：应用超声检测早期子宫瘢痕妊娠具有重要诊断价值，对临床治疗方式的选择有重要的指导意义。
Objective: ultrasonic ultrasonographic features of uterine scar pregnancy were retrospectively analyzed, this article probes into the value of ultrasonic testing for early diagnosis of scar pregnancy and clinical significance. Methods: a retrospective analysis of our hospital were suspected of 35 cases of patients with uterine scar pregnancy early ultrasound diagnosis information, the ultrasonic diagnosis and early surgical pathology confirmed results contrast analysis, evaluation of early ultrasound diagnosis effect. Results: 35 cases of uterine scar pregnancy patients, 33 cases of postoperative pathologic diagnosis of uterine scar pregnancy, the ultrasonic probe is audio-visual, 32 cases in line with the uterine scar pregnancy ultrasound diagnostic accuracy was 91.4% (32/35), ultrasound confirmed that early diagnosis and surgery has a positive correlation between the results. Conclusion: the application of ultrasonic testing early uterine scar pregnancy has important diagnostic value

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目的：探讨早孕期剖宫产瘢痕妊娠（CSP）经阴道手术的临床价值。方法对2010年6月~2013年6月我院收治的15例早孕期CSP患者的临床资料进行回顾性分析。结果15例CSP患者行经阴道子宫下段瘢痕妊娠病灶清除术＋子宫瘢痕修补术，手术时间短，出血少，术后恢复良好，均成功治愈，保留子宫。结论早孕期CSP行经阴道子宫下段瘢痕妊娠病灶清除术＋子宫瘢痕修补术易于暴露病灶，缝合及止血确切，手术时间短，出血少，术后恢复快，术后病率低，体表无瘢痕，具有安全、有效、微创及经济的特点，值得基层医院推广。
Objective To study the clinical value of vaginal excision and repair of Caesarean scar pregnancy during early pregnancy. Methods Start a retrospective analysis for 15 patients with cesarean scar pregnancy who were treated with vaginal excision and repair from June 2010 to June 2013. Results The study showed that 15 patients with cesarean scar pregnancy who were treated with vaginal excision and repair all reserved their uterine with shorter operative time , less blood loss and quicker recovery. Conclusion Vaginal excision and repair of Caesarean scar pregnancy made the scar lesion exposed easily, stitching and bleeding became exactly, the patients recovered quickly with shorter operative time ,less blood loss, lower postoperative morbidity, there was no scar in the surface of body. Thus it is safe,effective, minimally invasive and economical for patients with CSP. So it is worth of promoting by basic-level hospitals.

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子宫破裂是指在分娩或妊娠期子宫体或下段发生的破裂,是产科严重并发症,母婴围生期死亡率极高。子宫破裂分为瘢痕与非瘢痕子宫破裂,分娩过程中超过90%的子宫破裂发生于既往有剖宫产史的妇女。瘢痕子宫是子宫破裂最常见的高危因素,其中与前次手术瘢痕的位置、形式,缝合方法、术后愈合情况及术后妊娠间隔时间等因素密切相关。非瘢痕妊娠子宫破裂罕见,可能与梗阻性难产、子宫收缩药物使用不当、产科手术损伤及胎盘植入等高危因素有关。而妊娠晚期非瘢痕子宫自发性破裂非常罕见,原因尚不清楚。分娩过程中突然出现的胎心率异常应考虑是子宫破裂一个潜在的危险信号,而超声检查对于早期诊断至关重要。子宫破裂一经确诊,在10～30 min内实施手术是降低围生期永久性损伤以及胎儿死亡的主要治疗手段,但须综合考虑到子宫损伤的程度、患者生命体征是否平稳、将来的生育要求及医师的技术等因素选择不同术式。本文将子宫破裂的高危因素及诊疗现状进行综述。
Uterine rupture refers to the rupture of uterus or lower uterine segment during delivery or trimester of pregnancy, which is a serious complication of obstetrics and it causes a high mortality rate of mothers and children in the perinatal period. Uterine rupture can be classified into scared and non-scared rupture, and 90%of the uterine rupture during delivery occur in women with a history of cesarean section. Scared uterus is the most common risk factor of uterus rupture, which is closely related to the factors such as the previous location and form of the surgical scar, suture method, postoperative healing situation and pregnancy interval. The non-scared pregnancy uterine rupture is rare, which may be related to the high risk factors of obstructive dystocia, incorrect use of uterine contraction drugs, obstetric operation damage and placenta implantation. However, the spontaneous non-scared uterine rupture in late trimester of pregnancy is very rare, and the reason is not yet clear. T

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目的探讨B超监测在瘢痕子宫分娩方式选择上的指导意义。方法对200例剖宫产术后再次妊娠病例进行B超检测，并根据妊娠晚期子宫下段瘢痕厚度分组，其中〉3mm组147例，≤3mm组53例。结果所有产妇中成功阴道分娩者49例，占全部产妇的24．5％，其中瘢痕〉3mm的产妇43例，瘢痕≤3mm的产妇6例。结论应用B超动态观察检测子宫下段瘢痕厚度及愈合情况，可以预测子宫下段先兆破裂，从而选择恰当分娩方式，预防子宫破裂发生，减少并发症发生。
Objective To study the clinical significance of ultrasound detection on choosing the delivery mode for scar uterus. Methods 200 cases of subsequent pregnancy after cesarean section were detected by ultrasound. And according to the scar thickness of the lower uterine segment in the late trimester of pregnancy,they were divided into>3 mm group(147 cases) and ≤3 mm group (53cases). Results There were 49 cases with successful vaginal delivery,which accounted for 24.5% of all the parturient women. And there were 43 cases in > 3 mm group and 6 cases in ≤ 3 mm group. Conclusion The application of dynamic ultrasound for observation and detection of the scar thickness and healing situation of the lower uterine segment can predict the threatened uterine rupture to choose appropriate delivery mode,prevent uterine rupture and reduce complications.

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