腹腔镜下手术治疗外凸型子宫瘢痕妊娠的临床研究

Clinical study on laparoscopic surgery of cesarean scar pregnancy

目的探讨并分析腹腔镜手术治疗子宫瘢痕妊娠的适应证和疗效。方法该院2004年1月～2011年11月选择满足血β-HCG<20000mIU/mL的外凸型CSP患者共24例进行腹腔镜下瘢痕妊娠物切除+子宫修补术治疗,观察手术时间、术中出血量、术后血β-HCG下降时间、患者恢复正常月经时间及住院天数。结果 24例手术均成功,无手术并发症发生,手术平均时间63min,平均出血量62mL。所有患者术后2周内血β-HCG降为正常,术后4周内月经恢复正常,手术后平均住院天数6d(5～10d)。血β-HCG<10000mIU/mL的10例患者与血β-HCG10000～20000mIU/mL的14例患者相比,手术时间和术中出血量差异有显著性(P<0.05)。结论腹腔镜手术对于血β-HCG<20000mIU/mL的外凸型CSP患者是一种可行的治疗方法。尤其适用于血β-HCG<10000mIU/mL的外凸型CSP患者。腹腔镜手术治疗CSP具有出血少、操作时间短、血β-HCG下降迅速、住院时间短等优势,同时修复了子宫的形态保留了生育功能。

[ Objective ] To evaluate and analyze the indications and application value of laparoscopy surgery of cesarean scar pregnancy（CSP）. [ Methods ] 24 CSP patients with blood β-HCG〈20000 mIU/mL and pregnancy organization convex to the bladder were selected to be treated with laparoscopic surgery. The operation time, amount of bleeding, blood β-HCG down to normal time, resume normal menstrual and hospital stay were observed. [Results ] The 24 laparoseopy surgeries were all successfully completed, there was no complication appearance. The average operation time was 63 rain, the average amount of bleeding was 62 mL. All patients blood β-HCG down to normal within two weeks and resume normal menstrual within 4 weeks, the average hospital stay was six days （5-10d）. There were significant difference of the operation time and amount of bleeding between the 10 CSP patients with blood β-HCG〈10000 mlU/mL and the 14 CSP patients with blood β-HCG 10000-20000 mlU/mL （P 〈0.05）. [ Conclusion] To CSP patients with blood β-HCG〈20000 mlU/mL and pregnancy organization convex to the bladder the laparoscopy surgery is an effective therapy, especially for the blood β-HCG〈10000 mlU/mL patients. The laparoscopy surgery has predominance with less trauma and rapid recovery, at the same time recovering the uterus and reproductive function.