宫腹腔镜联合手术在剖宫产瘢痕妊娠治疗中的应用价值

Application Value of Hysteroscopy Combined with Laparoscopy in Treatment of Cesarean Scar Pregnancy

目的探讨联合应用宫腹腔镜在剖宫产瘢痕妊娠(cesarean scar pregnacy,CSP)治疗中的可行性及应用价值。方法回顾性分析2010年1月—2014年12月在石家庄市妇幼保健院诊治的20例CSP患者的病例资料,剖宫产瘢痕部位子宫浆肌层厚度均≤0.3 mm,手术方式采用宫腔镜下监测联合腹腔镜下子宫瘢痕病灶切除修补术,同时进行术后随访。结果 20例患者均治疗成功,无并发症发生。手术时间为(87.40±19.63)min,术中出血量为(97.55±33.13)ml。术后β-人绒毛膜促性腺激素恢复时间(34.00±4.68)d。20例患者均未再次发生CSP,有6例患者再次妊娠经剖宫产后分娩。结论对于剖宫产瘢痕部位子宫浆肌层厚度≤0.3 mm的CSP患者,联合应用宫腹腔镜治疗是安全、有效的手术方式。

Objective To investigate feasibility and application value of hysteroscopy combined with laparoscopy in treatment of cesarean scar pregnancy （ CSP） . Methods Clinical data of 20 CSP patients between January 2010 and December 2014 was retrospectively analyzed. Thickness of lower uterine myometrium in cesarean scar position was equal or less than 0. 3mm, and resection and neoplasty for scar lesion was performed under hysteroscopy combined with laparos-copy, and postoperative follow-up was also performed. Results Surgical treatment was successful in 20 patients without complication. Operative time was （87. 40 ± 19. 63） min, and intraoperative volume of blood loss was （97. 55 ± 33. 13） ml, and postoperative recovery time ofβ-human chorionic gonadotrop（h）in （β-HCG） was （34. 00 ± 4. 68） d. No CSP recurrence was found after operation, and 6 patients had given birth by vterine-incision delivery after pregnant again. Conclusion Hysteroscopy combined with laparoscopy in application of surgery for cesarean scar pregnancy women is safe and effective, whose thickness of lower uterine myometrium in cesarean scar position is equal or less than 0. 3mm.