经阴道手术治疗剖宫产术后子宫瘢痕部位妊娠

Transvaginal Evacuation for Caesarean Scar Pregnancy

目的探讨经阴道手术治疗剖宫产术后子宫瘢痕部位妊娠（caesareanscarpregnancy，CSP）的价值。方法对我科2009年8月至2012年8月收治的符合CSP诊断标准的21例患者行经阴道手术治疗，采用腰硬联合麻醉，膀胱截石位，按阴道手术常规操作，于宫颈阴道部与阴道前壁交界处，横向切开阴道前壁，上推膀胱腹膜反折2—3cm，暴露子宫前壁下段，见到病灶后，酌情切开子宫前壁下段，吸出病灶。结果2l例CSP行经阴道病灶切除联合子宫修补术，术后平均住院4（3～5）d。均获随访，所有患者手术后3周内血绒毛膜促性腺激素（p—humanchorionicgonadotrophin，p．HCG）降至正常，1～2个月月经恢复正常。结论经阴道手术治疗子宫瘢痕部位妊娠效果确切，疗效好，恢复快，值得临床推广应用。

Objective To discuss the value of the transvaginal evacuation for caesarean scar pregnancy （CSP）. Methods From August, 2009 to August, 2012 there were 21 cases of CSP undergone the transvagi- nal evacuation. All the patients were operated under the combined spinal and epidural anesthesia, and the pari- es anterior vaginase was transversally opened at the junction of the cervical vaginal portion and paries anterior vaginase, and then the peritoneal reflection was pushed up for 2 - 3 cm for the exposition of the lower segment of the anterior uterine, and the pregnancy cyst was aspirated and the uterus was repaired at last. Results All the operations of transvaginal evacuation combined excision repair got success in the 21 CSP cases with mean postoperative hospital stay of 4 （3 - 5） days. They were followed up for 2 months after surgery and all patients＂ serum 13-human chorionic gonadotrophin（]3-HCG） returned to normal within 3 weeks, and the normal menstrua- tion was resumed in 1 to 2 months. Conclusion The curative effect is good with quick recovery of the trans- vaginal surgery for the treatment of the caesarean scar pregnancy.