宫腔镜、腹腔镜治疗剖宫产瘢痕妊娠72例分析

Analysis on treatment effects of 72 cases cesarean scar pregnancy by hysteroscopy and laparoscopy

为了探讨宫腔镜和腹腔镜手术治疗剖宫产瘢痕妊娠(CSP)的指证及技术要点。回顾性地分析了首都医科大学附属北京妇产医院2013年1月—2013年12月收治的72例CSP患者的治疗情况。所有患者入院后行血清人绒毛膜促性腺激素(HCG)测定和三维彩超检查。根据局部病灶范围、HCG结果和多普勒B超血流结果,术前选择性行子宫动脉栓塞介入治疗或甲氨蝶呤治疗后,进一步行宫腔镜、腹腔镜或宫腹联合手术治疗。结果显示,30例采用超声监测下宫腔镜CSP病灶切除术,12例采用腹腔镜监护下宫腔镜CSP病灶切除术,30例采用宫腹腔镜联合CSP病灶切除+剖宫产瘢痕修补术,均收到了良好的治疗效果。术中出血量为(83±57)mL,术后肛门排气时间为(20±6.6)h,阴道流血时间为(3.2±4.8)d,血清HCG降至正常时间为(8.6±3.9)d,出院时间为(3.2±2.0)d。患者术后病理诊断与术前的CSP诊断符合率达到100%。研究得出,有剖宫产史的妇女再次妊娠时,有发生CSP的可能。超声或腹腔镜监护下宫腔镜CSP病灶切除术是治疗CSP的有效措施,病灶切除确切,创伤小;宫、腹腔镜CSP病灶切除+剖宫产瘢痕修补术在切除病灶,对后续有生育要求患者同时修复剖宫产瘢痕处解剖学异常,降低了再次妊娠时CSP和子宫破裂、胎盘植入等产科并发症的风险。

To investigate the effects of hysteroscopic and laparoscopic operation in the treatment of cesarean scar pregnancy（CSP）,a retrospective analysis of 72 cases of CSP patients in Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University from January to December in 2013. All the patients were dignosised through serum human chorionic gonadotropin and three-dimensional color Doppler ultrasound examination. According to the local range of lesion,HCG results and Doppler ultrasound blood flow results,preoperative selective uterine artery embolization or methotrexate treatment was carried out,then further hysteroscopy,laparoscopy or combined with operation therapy was carried out. The results showed,30 cases underwent ultrasonic monitoring hysteroscopic lesion resection,12 cases were treated with laparoscopic monitoring CSP lesion resection under hysteroscopy,30 cases were treated with laparoscopy to resect lesion and repair cesarean scar,all of them received good treatment effect. The average amount of bleeding was（83±57） mL,postoperative anal exhaust time was（20±6.6） h,the time of vagina bleeding was（3.2±4.8） d,serum HCG decreased to normal time was（8.6±3.9） d,the time to discharge was（3.2±2） d. Patients with postoperative pathological diagnosis and preoperative CSP diagnosis coincidence rate was 100 %. Women with the history of cesarean section pregnancy have the possibility of CSP. Ultrasound or laparoscopy by hysteroscopy monitored CSP lesion resection is an effective treatment for CSP. It has many advantages such as excision exact,small trauma,laparoscopic lesion excision and cesarean scar repair surgery,fertility requirements of patients while repairing a cesarean scar anatomy abnormality on follow-up,and can reduce pregnancy at CSP and rupture of the uterus,placenta accreta obstetric complications such as risk.