宫腔镜联合阴式手术切除子宫切口瘢痕妊娠病灶临床效果分析

Clinical Effect Analysis on Hysteroscope-assisted Transvaginal Cesarean Scar Pregnancy Debridement Surgery

目的：探析宫腔镜联合阴式手术切除剖宫产子宫切口瘢痕妊娠病灶的临床效果。方法：回顾性分析2010年1月-2015年6月本院收治的75例剖宫产子宫切口瘢痕妊娠患者各种治疗方法疗效的临床资料,其中应用药物甲氨蝶呤（MTX）杀胚后清宫术治疗18例,清宫术2例,宫腔镜检查加清宫术或电切术11例,腹腔镜手术治疗6例,宫腔镜联合阴式手术切除子宫切口瘢痕妊娠病灶38例（经以上治疗效果欠佳,转开腹手术治疗6例）。结果：MTX杀胚后清宫术治疗,效果好,治疗有效率为83.33%,但住院时间长,血β-h CG下降慢,均于25~40 d转阴性,有药物副反应;宫腔镜加清宫术或电切术,对子宫瘢痕妊娠内生型效果良好,治疗有效率90.91%,但对外生型病灶有子宫穿孔风险;腹腔镜手术对外生型病灶治疗效果良好,治疗有效率100%,但操作技术要求高,费用高,对内生型子宫肌层创伤大;开腹手术效果良好,尤其是急性大出血的紧急处理,但腹部伤口创面损伤大;宫腔镜联合阴式手术切除剖宫产子宫切口瘢痕妊娠病灶,适合内外型病灶的手术,同时可予修补存有子宫瘢痕憩室的手术,患者阴道流血少,无明显并发症,治疗有效率为97.37%,血β-h CG术后15~25 d均降至正常范围。结论：宫腔镜联合阴式手术切除剖宫产子宫切口瘢痕妊娠病灶,效果好,安全性高,值得临床推广。

Objective： To study the clinical effect of hysteroscope-assisted transvaginal cesarean scar pregnancy debridement surgery.Method： A retrospective analysis of the efficacy of 75 cases of cesarean scar pregnancy admitted in our hospital from January 2010 to June 2015, methotrexate （ MTX ） in curettage treatment after killing the embryo were applied 18 cases, curettage was adopted in 2 cases, hysteroscopy check plus curettage or transurethral resection were used in 11 cases, laparoscopic surgery was used in 6 cases, hysteroscopy assisted transvaginal cesarean scar pregnancy debridement surgery were used in 38 cases （ 6 cases of the above mentioned were converted to gynecological open surgery after ineffective treatment ） .Result： MTX treatment after curettage enjoyed good effect, the cure rate was 83.33%, but with a long hospital stay, slow blood [5 -hCG decline, and negative resistance after 25-40 d, there were side effects of medication.Hysteroscopy check plus curettage or transurethral resection of the intra-uterine scar pregnancy had good effect, the cure rate was 90.91%, but the external-type lesions had the risk of uterine perforation.Laparoscopic surgery of external-type lesion had good effect, the cure rate was 100%, but with high technical requirements for the operation and high cost, while the endogenous type had myometrium trauma.Laparoscopic surgery had good effect, especially in the emergency treatment of acute bleeding, but abdominal wound was large.Hysteroscopy-assisted transvaginal cesarean scar pregnancy debridement surgery were suitable for both the endogenous type and the external-type lesions surgery to repair at the same time the uterine scar diverticulum surgery, the patient had less vaginal bleeding, no significant complications were found, the cure raie was 97.37%, the blood β -hCG were dropped down to the normal range after 15-25 d.Conelusion： Hysteroscopy-assisted transvaginal cesarean scar pregnancy debridement surgery is proved to be effective and safe, therefore it is worthy of clinical application：