宫、腹腔镜在剖宫产瘢痕妊娠治疗中的应用

Laparoscopy or Hysteroscopy for Cesarean Scar Pregnancy

目的探讨宫、腹腔镜治疗剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的可行性及价值。方法回顾性分析2003年1月～2009年11月我院行宫、腹腔镜下CSP病灶切除的10例资料,术前均用甲氨蝶呤(MTX)化疗或子宫动脉栓塞预处理。2例子宫前壁下段内不均质混合性包块向宫外突出,近突破子宫浆膜层,包块直径>3 cm,采用腹腔镜下病灶切除,余8例宫腔镜下病灶切除。结果 10例均治疗成功,无并发症发生。术后血β-hCG恢复正常时间14～36 d,正常月经来潮时间20～40 d。5例宫腔镜手术者再次妊娠,其中1例再次CSP,行MTX保守治疗治愈。结论宫、腹腔镜下CSP病灶切除,是CSP微创治疗的可行方法。

Objective To analyze the feasibility and value of hysteroscopy or laparoscopy for the treatment of cesarean scar pregnancy （ CSP）. Methods We retrospectively analyzed the data of 10 cases of CSP who received hysteroscopy or laparoscopy in our hospital since January 2003 to November 2009. Preoperative chemotherapy or ulerine artery embolization with MTX were carried out in all the patients. Among the cases, laparoseopy were performed on 2 patients, who had unhomogeneous mixed mass in the anterior lower uterus shown by B-ultrasonography; the other 8 patients underwent hysteroscopy. Results The procedures were completed successfully in all the cases without complications. The level of serum [3-hCG decreased to a normal range in 14 to 36 days postoperation, and the patients recovered normal menses in 20 to 40 days. ht the 8 cases of hysteroseopy, 5 patient had pregnant＇y again, and one of them showed CSP, which was then cured by conservative treatment with MTX. Conclusion tlysteroscopic and laparoscopic excision is feasible for CSP.