宫、腹腔镜治疗剖宫产瘢痕妊娠21例临床分析

Hysteroscopy and Laparoscopy in the Treatment of Cesarean Scar Pregnancy: a Retrospective Analysis of 21 Cases

目的探讨宫、腹腔镜治疗剖宫产瘢痕妊娠（cesarean scar pregnancy,CSP）的安全性及可行性。方法回顾性分析2014年3月~2015年9月21例CSP的资料,其中内生型12例（其中Ⅰ型6例,Ⅱ型6例）,外生型9例（其中Ⅱ型8例,Ⅲ型1例）。行宫腔镜下清宫6例（Ⅰ型5例,Ⅱ型1例,均为内生型）;腹腔镜监护下宫腔镜下瘢痕妊娠物电切4例（Ⅰ型1例,Ⅱ型3例,均为内生型）;腹腔镜下瘢痕妊娠病灶切除＋子宫修补术＋宫腔镜检查11例（Ⅱ型10例,Ⅲ型1例,包括2例内生型,9例外生型）。结果腹腔镜监护下宫腔镜下瘢痕妊娠物电切术2例因病灶位于瘢痕憩室内,宫腔镜下手术困难,行腹腔镜下病灶切除;腹腔镜下瘢痕妊娠病灶切除＋子宫修补术＋宫腔镜检查术1例术中出血1100 ml;余18例均顺利完成手术。血β-h CG术后2~4周恢复正常,4~6周月经恢复。结论宫、腹腔镜联合治疗CSP是安全可行的。

Objective To discuss the safety and feasibility of hysteroscopy and laparoscopy in the treatment of cesarean scar pregnancy（ CSP）. Methods A retrospective analysis was conducted on clinical data of 21 patients with CSP from March 2014 to September 2015. There were 12 endogenous cases（ 6 type Ⅰ and 6 type Ⅱ,respectively） and 9 exogenous cases（ 8 type Ⅱ and 1type Ⅲ）. Curettage and hysteroscopy（ group A） was performed in 6 cases（ 5 type Ⅰ and 1 type Ⅱ,all endogenous）; hysteroscopic surgery with laparoscopic monitoring（ group B） was performed in 4 cases（ 1 type Ⅰ and 3 type Ⅱ,all endogenous）; laparoscopic surgery with hysteroscopy（ group C） was performed in 11 cases（ 10 type Ⅱ and 1 type Ⅲ,2 endogenous and 9 exogenous）.Results In the group B,2 cases was treated under laparoscopy for difficultly in hysteroscopy surgery. In the group C,1 case encountered intraoperative blood loss of 1100 ml,and the remaining 18 cases were successful. The level of serum β-h CG was decreased to normal range in 2- 4 weeks,and the patients recovered normal menses in 4- 6 weeks. Conclusion Hysteroscopy and laparoscopy are safe and feasible in the treatment of CSP.