成功处理合并动静脉畸形的剖宫产瘢痕妊娠
Successful Management of Cesarean Scar Pregnancy Complicated by an Arteriovenous Malformation.
作者信息
Smith Evan S, Gala Rajiv B
机构信息
Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, LA.
Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
出版信息
Ochsner J. 2015 Fall;15(3):268-71.
BACKGROUND
Cesarean scar ectopic pregnancies are rare, with an incidence of approximately 1 in 2,000 pregnancies. The trauma of a cesarean section and a subsequent cesarean scar pregnancy can lead to the formation of an arteriovenous malformation (AVM). The resulting intractable bleeding is difficult to manage and can result in an emergent surgical intervention that could jeopardize a female's ability to become pregnant in the future.
CASE REPORT
A 29-year-old female, gravida 2 para 1, with 1 prior low transverse cesarean section had a presumed cervical ectopic pregnancy treated with intramuscular methotrexate. Despite a negative serum beta human chorionic gonadotropin result, she had a persistent mass in the lower uterine segment of her cesarean section scar and was finally diagnosed with an AVM. We successfully preserved her fertility by performing a wedge resection of the AVM and using a novel technique of bilateral O'Leary sutures to occlude the ascending and descending branches of the uterine artery along with intramuscular vasopressin infiltration.
CONCLUSION
A multidisciplinary approach involving obstetrics/gynecology, interventional radiology, and anesthesiology allowed for a safe conservative surgical approach and the preservation of our patient's fertility.
背景
剖宫产瘢痕部位异位妊娠较为罕见，发生率约为两千分之一。剖宫产手术创伤及随后的剖宫产瘢痕妊娠可导致动静脉畸形（AVM）形成。由此引发的难治性出血难以处理，可能需要紧急手术干预，这可能会危及女性未来的受孕能力。
病例报告
一名29岁女性，孕2产1，既往有1次低位横切口剖宫产史，疑似宫颈异位妊娠，接受了甲氨蝶呤肌内注射治疗。尽管血清β-人绒毛膜促性腺激素结果为阴性，但她剖宫产瘢痕子宫下段仍有持续肿块，最终被诊断为动静脉畸形。我们通过对动静脉畸形进行楔形切除术，并采用一种新型技术，即双侧O'Leary缝合术来阻断子宫动脉的升支和降支，同时进行肌内血管加压素浸润，成功保留了她的生育能力。
结论
多学科方法，包括妇产科、介入放射科和麻醉科，实现了安全的保守手术方法，并保留了我们患者的生育能力。
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