宫腹腔镜联合治疗剖宫产切口妊娠37例临床观察

The efficacy of hysteroscopy combined with laparoscopy in the treatment of Cesarean scar pregnancy: a study of 37 cases

目的探讨宫腔镜及腹腔镜在剖宫产切口妊娠(cesarean scar pregnancy,CSP)诊断及治疗中的应用价值。方法回顾性分析2013年1月至2015年1月收治的血清人绒毛膜促性腺激素(HCG)>5 000 m IU/ml的CSP患者37例。患者入院后行血HCG测定和三维彩色超声多谱勒检查,均在腹腔镜下先行双侧子宫动脉结扎,随后对于内生型的患者行腹腔镜监护下宫腔镜下CSP病灶切除,而外生型的患者则行宫腹腔镜联合CSP病灶切除+剖宫产瘢痕修补术。结果本组中20例为外生型,17例为内生型。经宫腹腔镜联合治疗一次成功,术中出血量(83±32)ml,术后肛门排气时间(19.0±7.6)h,术后阴道流血时间(6.2±2.9)d,血清HCG降至正常时间(9.6±3.0)d,出院时间(4.2±1.8)d,无1例并发症发生。结论宫腹腔镜联合治疗剖宫产切口妊娠微创、术后恢复快、临床效果确切,是保留器官生殖功能的有效措施,值得在临床推广。

Objective To investigate the value of hysteroscopy and laparoscopy in the diagnosis and treatment of cesarean section scar pregnancy （CSP）. Methods From January 2013 to January 2015, thirty seven cases of CSP whose serum human chorionic gonadotropin （HCG） was greater than 5000 mIU in the minimally invasive center of Beijing Obstetric and Gynecologic Hospital, were retrospectively analyzed. After admission, serum HCG was determined and threedimensional color Doppler ultrasound was examined. Based on the ultrasonography, CSPs were classified as the endoge- nous or the exogenous cases. Laparoscopic uterine arteries ligation was performed firstly in all cases. Then for endogenous ones, the lesions were excised with hysteroscopy by laparoscopy monitoring. For exogenous cases, the CSP were excised by laparoscopy and the cesarean scar defects were repaired simultaneously. Results There were 20 exogenous cases and 17 endogenous cases. All cases were successfully treated without complications in this study. Intraoperative blood loss was （83±32） ml. The average time for the bowel movement recovery was （19±7.6） h. After operation, vaginal bleeding had lasted for （6.2±2.9） days. The average time for serum HCG dropped to normal level was （9.6±3.0） days. The average length of stay was （4.2±1.8） days. Conclusion Laparoscopy combined with hysteroscopy is the minimally invasive method for CSP treatment. With the advantage of rapid postoperative recovery and the promising clinical effect, it is a valuable treatment to spare fertility and is worthy of practicing.