腹腔镜联合治疗剖宫产瘢痕妊娠的疗效分析

Clinical analysis of laparoscopic combined treatment of cesarean scar pregnancy

目的探讨腹腔镜联合治疗在剖宫产瘢痕妊娠中的有效性及优势。方法回顾我院近十年收治的剖宫产瘢痕妊娠病人44例,依据超声及临床症状进行分组,采用不同的治疗方案,治疗方法包括双侧子宫动脉栓塞(UAE)+彩超监测下清宫或宫腔镜下电切;MTX+米非司酮+中药药物治疗后+超声引导下清宫或宫腔镜下电切;腹腔镜直视下清宫+瘢痕处切除修补;经腹或腹腔镜下子宫切除术。观察各种治疗方案的疗效、出血量、住院时间、费用、并发症、HCG下降情况、愈后等方面,同时进行对比分析。结果应用腹腔镜手术治疗瘢痕妊娠28例,其中一例因肌层薄,无生育要求,术中出血多,中转行子宫切除术;28例病人术后无并发症,治疗效果明确,恢复快,保留病人生育能力,且在住院时间、费用方面优于传统治疗。结论对于非急性出血期的剖宫产瘢痕妊娠病人,尤其针对瘢痕处肌层薄弱病例,腹腔镜联合治疗可作为剖宫产瘢痕妊娠的优选治疗方案。但需有经验的妇科腔镜手术医师指导进行。

Objective：To explore the effectiveness and advantages of laparoscopy combined treatment in cesarean scar pregnancy. Methods：With retrospective analysis for 44 cesarean scar pregnancy patients in our hospital recent ten years,according to the ultrasound and clinical symptoms patients were grouped using the different treatment. Treatments included bilateral uterine arterial embolization（UAE） ＋ curettage or hysteroscopic electric cutting;MTX and traditional Chinese medicine treatment ＋ incision curettage or hysteroscopy;laparoscopy curettage ＋ scar excision repair. Then amount of bleeding,hospitalization time,expense,complications,hCG decreased and prognosis of score were detected to observe the effect. Results：In the 28 patients who received laporoscopic surgery,1 case was converted to hysterectomy because of no fertility requirements and intraoperative bleeding. 28 cases of patients were cured without complications,and treatment effect was clear with the fast recovery and retaining a patient fertility;and at the time of hospitalization,cost was lower that the traditional treatment. Conclusion：Laparoscopic combined treatment can be used as the first choice in the treatment of cesarean scar pregnancy in patients with non acute hemorrhage. The surgery need the guidance by experienced gynecological laparoscopic doctor.