36例子宫切口妊娠的临床分析

Clinical analysis of 36 cases of cesarean scar pregnancy

目的:探讨宫、腹腔镜和子宫动脉栓塞术在CSP治疗中的应用。方法:回顾性分析2010年1月-2016年4月收治的36例CSP患者。其中内生型患者行腹腔镜辅助宫腔镜下子宫切口妊娠物清除术;外生型患者行宫腹腔镜联合子宫切口妊娠物清除+子宫切口憩室修补术。部分胚胎活性高、病变部位血供丰富的患者术前48小时行介入治疗。结果:36例患者中内生型23例,外生型13例均经一次手术治愈,手术时间(56.7±9.21)min;术中出血量(86±41)m L;术后阴道流血时间(5.1±1.2)天;血HCG降至正常时间(10.7±4.6)天;无膀胱及肠管损伤患者,无水中毒及低钠血症患者,所有患者术后随访2个月均有1次月经来潮,且无明显月经量减少和月经期延长。结论:CSP患者应早期诊断,及时终止妊娠,采用宫、腹腔镜联合方式手术,且选择性术前给予介入治疗是对于子宫切口妊娠比较有效的治疗方法,值得临床借鉴。

Objective:To explore the application of hysteroscopy, laparoscopy and uterine artery embolization in the treatment of CSP. Methods:Retrospective analysis of 36 patients with CSP admitted from January 2010 to April 2016. Hysteroscopy by laparoscopy auxiliarling be used for endogenous cases. For exogenous,we used laparoscopy and hysteroscopy and repairing of the uterine incision diverticulum. For part case of the high activity of the embryo, and the rich blood supply to lesion site,we used uterine artery embolization 48 hours before the intervention treatment. Results:All the patients were cured by one operation. Operation time(56.7±9.21) min; intraoperative blood loss(86±41) m L;postoperative vaginal bleeding time(5.1±1.2) days; blood HCG dropped to normal time(10.7±4.6)days; patients without bladder and bowel injury, anhydrous poisoning and hyponatremia patients. All patients were followed up for 2 months,everyone has a period of menstruation. No significant reduction in the amount of menstrual cycle and the occurrence of prolonged menstrual period. Conclusion:CSP patients should be early diagnosis, timely termination of pregnancy. Using of hysteroscopy and laparoscopy,combined with appropriate anduterine artery embolization,is an effective treatment for CSP. It is worthy of clinical reference.