宫腔镜联合清宫术治疗内生型剖宫产瘢痕妊娠32例临床分析

Clinical analysis on hysteroscope and suction curettage for treatment for endogenous cesarean scar pregnancy

目的探讨宫腔镜检查联合清宫术治疗内生型剖宫产瘢痕妊娠(CSP)的临床应用价值。方法回顾广州市妇女儿童医疗中心2014年11月至2016年3月经阴道超声诊断为内生型CSP患者32例,应用宫腔镜检查联合清宫术或清宫术加宫腔内球囊压迫治疗,评估阴道超声诊断的符合率、手术时间、术中出血量、术后血β-人绒毛膜促性腺激素(β-HCG)下降的情况以及月经恢复的时间,同时观察不同孕周、血β-HCG水平及瘢痕厚度对手术时间及术中出血量的影响。结果经宫腔镜检查4例患者妊娠囊着床在宫颈内口后壁或侧后壁,排除瘢痕妊娠,超声误诊率为12.5%,符合率为87.5%。28例CSP均1次手术成功,无手术并发症。手术时间(29.57±9.86)min,术中出血量(28.75±14.18)m L。停经天数<49 d与≥49 d相比,手术时间明显缩短(P<0.01),术中出血量明显减少(P<0.05)。血β-HCG<20 k U/L者与≥20 k U/L相比,手术时间和术中出血量两组之间差异有统计学意义(P<0.05)。瘢痕厚度<3.0 mm与≥3.0 mm相比,手术时间及术中出血量两者之间差异无统计学意义(P>0.05)。术后第1天血β-HCG较术前均下降≥50%,术后28 d内血β-HCG均降至正常。月经来潮平均在术后(36.50±4.99)d,超声检查宫腔内无组织物残留。结论宫腔镜检查联合清宫术治疗内生型CSP具有出血少、操作简单、成功率高、并发症少、住院时间短、费用低等优点。

Objective To investigate clinical application value of hysteroscopy and suction curettage in the treatment of endogenous cesarean scar pregnancy （CSP）. Methods A retrospective evaluation of 32 patients who were diagnosed as endogenous CSP by transvaginal ultrasound were treated by hysteroscopy and suction curettage with or without placement of a uterine Foley balloon from November 2014 to March 2016 in our hospital. Diagnosis coincidence rate of transvaginal ultrasound, operative time, amount of intraoperative blood loss, decreasing β-HCG level and resumed menstruation were evaluated. We also observed the operation time and amount of bleeding in the corresponding group categorized according to different gestational weeks, β-HCG level and myometrial thickness respectively. Results 4 patients were excluded CPS by hysteroscopy. Ultrasound misdiagnosis rate of CPS was 12.5%. The 28 patients were diagnosed CPS by hysteroscopy were operated successfully without any complication. The mean operation time was 29.57±9.86 min , and the mean blood loss was 28.75±14.18 mL. There were significant difference of the operation time and amount of bleeding between the menopause ≤ 49 days and 〉 49 days, and between serum β-HCG 〈 20 kU/L and serum β-HCG≥20 kU/L respectively. There were no significant difference between group whose myometrial thickness was 〈 3.0 mm and ≥3.0 mm. The HCG level of the first day after operation was deceased more than 50% in all the patients and became negative 28 days later. The average time resumed menstruation after operation was 36.50±4.99 days. There was no residue by repeated ultrasound examination. Conclusions Hysteroscopy and suction curettage for endogenous CSP has advantages of less bleeding, simple performance, high suc cess rate, less complications, shorter hospitalization time and lower expense.