臺灣博碩士論文加值系統

前言
剖腹產疤痕懷孕在過去是一個少見且致命疾病。過去一二十年剖腹產疤痕懷孕率隨著剖腹生產率上升而增加。早期診斷可以避免子宮破裂、大出血、子宮切除及一連串的母體的疾患，此外也可以盡早使用保守的治療來處理剖腹產疤痕懷孕，使子宮得以保留。目前而言，雖然有好幾種治療的方式被建議，但處理剖腹產疤痕懷孕最適當的治療仍未確立。在此我們探究以子宮動脈栓塞合併子宮內膜刮除手術是否為治療剖腹產疤痕懷孕最好的方式。
方法
這是一個回溯性的研究，收入在2001年1月與2010年12月間在彰化基督教醫院中以子宮動脈栓塞合併子宮內膜刮除手術治療剖腹產疤痕懷孕的婦女，評估其治療療效及治療後對生育能力的影響。本研究有經過彰化基督教醫院的人體試驗委員會的審查。我們回顧病例，將正常的子宮內懷孕及不可逆的流產的患者誤診為剖腹產疤痕懷孕的個案刪除掉。根據病歷紀錄病人的年齡、生產史、診斷週數、子宮內膜刮除手術術中出血量、有無併發症、診斷時人類絨毛膜促性腺激素(β-HCG)的數值及術後人類絨毛膜促性腺激素(β-HCG)下降到正常數值的天數(<10mIU/ml)及住院天數。並以電話聯繫病人，追蹤其治療後第一次月經來潮的時間、治療後是否有避孕及其方式、之後若有懷孕，懷孕的結果如何等。
結果
一共收納34位以子宮動脈栓塞合併子宮內膜刮除手術治療剖腹產疤痕
懷孕的婦女這些患者的平均年齡為34.4±5.68歲。其中有44.1%的病人曾接受過2次以上的剖腹生產手術。子宮內膜刮除手術術中的平均出血量為17.1±8.5毫升。平均住院天數為3.56±1.41天。在30個有聯絡上的病人中，有29個治療後第一次月經是在術後一至兩個月發生；而這些病人中有7個後來有再度懷孕:3個以剖腹產方式順利的足月生產；有2個病人不想再生小孩，所以接受人工流產手術，其中一個病人同時將輸卵管結紮。而剩餘的2個患者再度遭遇子宮外孕，其中一個為右側輸卵管懷孕，接受腹腔鏡手術治療；而另一個為重複性剖腹產疤痕懷孕，病人再度接受了子宮動脈栓塞合併子宮內膜刮除手術治療，治療過程順利無併發
症。
結論
以子宮動脈栓塞合併子宮內膜刮除手術來治療剖腹產疤痕懷孕為一有
效的治療方式。它不但有保留了未來的生育能力、治療過程中只有少量的出血、且無明顯併發症，而住院天數也不長的優點。然而重複性的剖腹產疤痕懷孕的發生是需要去注意的。根據本研究的結果，我們建議可以將子宮動脈栓塞合併子宮內膜刮除手術當成剖腹產疤痕懷孕的第一線治療方式。

Introduction
Caesarean scar pregnancy (CSP) is a rare and lethal disorder in the past. Increasing incidence was noted following rising Caesarean section rate in last 2 decades. Early diagnosis can avoid uterine rupture, major hemorrhage, hysterectomy and serious maternal morbidity, which allowed the use of conservative treatments to preserve the uterus. The most appropriate management of CSP is not clear, although several treatment modalities have been proposed. We presented our experiences of CSP treated with dilation and curettage (D&C) after uterine artery embolization (UAE).
Method
The study was retrospective to review those women who received UAE and D&C for CSP between Jan 2001 and Dec 2009. We excluded those patients who were misdiagnosed as normal early intrauterine pregnancy or inevitable miscarriage before D&C. Gestational age, vaginal bleeding amount during D&C, hemoglobin, and hospitalization time were all recorded.
Result
34 women with CSP were managed in our unit. The women’s average age was 34.4± 5.68 years. 44.1% of these patients have undergone multiple (≧2) cesarean sections. The
average of blood loss during D&C was 17.1±8.5 ml. The average hospitalization time was 3.56±1.41 days. The uterus was conserved in all cases (100%). Menstruation
resumed normal in 29 patients one or two months later. 7 out of the 34 women were pregnant again during follow-up. Three gave birth by C/S in term without any
complications. D&C had been performed on two women whom didn’t want more babies and one of them received tubal ligation at same time. The other two patients suffered
from ectopic pregnancies. One is right tubal pregnancy, who received laparoscopic surgery. The other is a recurrent CSP and received D & C followed UAE again without complications.
Conclusion
To treat CSP with UAE and D & C is an effective method. It preserves fertility and has fewer blood loss, complication and hospitalization time. However, recurrent CSP must be
attended. Based on the results of this series, we suggest that D & C followed UAE can be used as the primary treatment for CSP.

圖目錄
表目錄
中文摘要
論文內容
第一章 前言 …………………………………1
第二章 文獻探討 …………………………2
第三章 材料與方法 …………………………9
第四章 結果 ………………………………..10
第五章 討論 ………………………………11
第六章 結論 ………………………………14
參考文獻 ………………………………………15
附錄 ……………………………………………19
英文摘要 ………………………………29
作者簡歷 ……………………………31
謝辭 …………………………………32

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