经阴道手术在剖宫产瘢痕妊娠治疗中的应用

Application of Transvaginal Surgery in Treatment of Cesarean Scar Pregnancy

目的探讨剖宫产瘢痕妊娠(CSP)的最佳手术治疗方法。方法将20例CSP患者根据治疗方法的不同分为2组,清宫组(12例)及经阴道病灶切除组(8例)。清宫组予口服米非司酮150 mg+甲氨蝶呤(MTX)50mg.m-2肌内注射,共1～3次。待血β-HCG值下降接近正常、阴道超声检查子宫局部血流不丰富后在超声监测下行清宫术。经阴道病灶切除组中4例术前使用MTX 50mg.m-2肌内注射,待血β-HCG下降到一定程度后行手术;另4例直接行经阴道病灶切除。对2组患者术中出血量、手术时间、住院时间及血β-HCG转阴时间进行比较。结果经阴道病灶切除组的术中出血量、住院时间及血β-HCG转阴时间均明显低于对照组(均P<0.05)。2组手术时间比较差异无统计学意义(P>0.05)。结论经阴道病灶切除术治疗CSP具有经济、微创、安全有效的特点,有望成为今后治疗CSP的最佳手术方式。

Objective To investigate the optimal surgical method for the treatment of cesarean scar pregnancy（CSP）.Methods Twenty patients with CSP were treated with complete curettage of uterine cavity（complete curettage group,n=12）or transvaginal lesion resection（transvaginal resection group,n=8）.Complete curettage group was give oral mifepristone（150 mg） and intramuscular injection of methopterin（50 mg·m-2） 1-3 times,and complete curettage of uterine cavity was performed under ultrasonic monitoring after blood β-HCG returned to near-normal levels and transvaginal ultrasonography showed regional blood flow signals.In transvaginal resection group,4 patients underwent transvaginal lesion resection after treatment with intramuscular injection of mifepristone（50 mg·m-2） once for decreasing β-HCG levels,and the other 4 patients only receive transvaginal lesion resection.Operating time,blood loss,hospital stay and β-HCG clearance time were compared between the two groups.Results Compared with complete curettage group,blood loss,hospital stay and β-HCG clearance time significantly decreased in transvaginal resection group（all P0.05）.But there were no obvious differences in operating time between the two groups（P0.05）.Conclusion Transvaginal resection group is an economical,minimally invasive,safe and effective procedure and may be the optimal surgical method for the treatment of CSP.