腹腔镜下子宫瘢痕妊娠切开取胚术的临床研究

Clinical study of laparoscopic treatment of uterine scar pregnancy

目的探讨腹腔镜下子宫瘢痕妊娠（CSP）切开取胚术的临床应用价值及特点。方法回顾性分析22例行腹腔镜下CSP切开取胚术患者的临床资料,其中内生型6例,外生型16例;术前B超检查提示局部血流丰富18例,有胎心搏动12例,血人绒毛膜促性腺激素（β-HCG）〉1万m IU/ml有14例。结果 22例手术均成功,无手术并发症发生,手术时间平均（75.7±15.2）min,术中出血平均（80.5±20.4）ml。患者术后血β-HCG降为正常时间平均（14.6±5.2）d,月经恢复正常时间平均（30.7±10.2）d;术后住院时间6 d（5-10 d）。与内生型患者相比,外生型患者手术时间短,术中出血少,术前B超检查提示局部血流丰富,有胎心搏动;血β-HCG〉1万m IU/ml患者手术时间长,术中出血多,差异有统计学意义（P〈0.05）。结论腹腔镜下CSP切开取胚术是一种可行的治疗方法,尤其适用于血β-HCG〈1万m IU/ml的外生型CSP患者。腹腔镜手术治疗CSP具有术中出血少、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,值得临床推广应用。

Objective To investigate the advantage of laparoscopic treatment of uterine scar pregnancy. Methods To review 22 cases of laparoscopic treatment of uterine scar pregnancy, the endogenous type 6 cases,and the exogenous 16 cases,preoperative B-mode ultrasonography showed local rich blood flow 18 cases,there were 12 cases with fetal heart beat,β-HCG〉 10 000 m IU / ml 14 cases.Results 22 cases had successful operation,no complications occurred,the average time of operation was（ 75. 7 ± 15. 2） min,the average bleeding volume was（ 80. 5 ± 20. 4） ml. The bloodβ-HCG was decreased to（ 14. 6 ± 5. 2） days after operation,and the average length of the period was（ 30. 7 ± 10. 2） days,the average length of hospital stay was 6 days（ 5 to 10 days）. And endogenous compared,exogenous surgery a short time,less bleeding; preoperative B-ultrasound local abundant blood,fetal heart beat,longβ-HCG 〉10 000 m IU / ml of patients with operation time,intraoperative blood loss,the difference is significant（ P〈0. 05）. Conclusions Laparoscopic treatment of CSP in patients with uterine scar pregnancy is a feasible method. Especially suitable for patients with β-HCG〈 10 000 m IU / ml CSP. Laparoscopic surgery for the treatment of CSP with less bleeding, short operation time, blood β-h CG decreased the rapid, short hospitalization time and other advantages,and repair of the uterine morphological preservation of fertility,it is worth of clinical application.