宫腹腔镜联合B型超声在治疗外凸型未破裂宫角妊娠的应用

Clinical Application of the Hysteroscopy Combined with Laparoscopy and Ultrasound in Treatment of Non-Ruptured and Evagination Type Cornual Pregnancy

目的:探讨宫腹腔镜联合B型超声(B超)在外凸型未破裂宫角妊娠诊治方面的价值。方法:回顾性分析首都医科大学附属北京妇产医院2013年7月—2019年7月收治的36例外凸型未破裂宫角妊娠患者行宫腹腔镜联合B超诊治的临床资料。结果:36例患者均一次性完成手术,其中31例患者行腹腔镜及B超监护下宫腔镜下胚物切除术及吸宫术,术中均未发生子宫破裂,手术时间30~110 min,平均50(35,70)min,术中出血量15~100 mL,平均50(21,58)mL;5例患者因吸宫及宫腔镜手术后仍有大部分妊娠组织无法清除行腹腔镜下宫角切开取胚术或宫角楔形切除术+患侧输卵管切除术,手术时间70~130 min,平均(91±21)min,术中出血40~200 mL,平均(94±56)mL。所有患者在术后2个月内血人绒毛膜促性腺激素β亚单位(β-hCG)水平恢复正常。结论:宫腹腔镜联合B超治疗外凸型未破裂宫角妊娠是一种微创、安全有效的方法。

Objective:To evaluate the value of the hysteroscopy combined with laparoscopy and ultrasound in the diagnosis and treatment of non-ruptured and evagination type cornual pregnancy.Methods:The clinical data of 36 patients with non-ruptured and evagination type cornual pregnancy were retrospectively analyzed,who were treated by the hysteroscopy combined with laparoscopy and ultrasound in our hospital from July 2013 to July 2019.Results:The one-time operation processing was completed in 36 cases,including 31 cases with the hysteroscopic resection of embryo and uterine aspiration guided by laparoscopy and ultrasound.There was none of metrorrhexis during the operation.The operation time of above 31 patients was 50(35,70)min(varied from 30 min to 110 min),and the amount of blood loss 50(21,58)mL(ranged from 15 mL to 100 mL).Five patients were treated by the laparoscopic cornua uteri dissection and removing embryo or cornua uteri wedge resection and unilateral salpingectomy,because the majority of pregnant tissue was unable to be removed by uterine aspiration and hysteroscopic surgery.The operation time of 5 patients was(91±21)min(varied from 70 min to 130 min),and the amount of blood loss(94±56)mL(ranged from 40 mL to 200 mL).The level of serum hCG returned to the normal range in 2 months after surgery.Conclusions:The hysteroscopy combined with laparoscopy and ultrasound is a minimally invasive,safe and effective method in treating the non-ruptured and evagination type cornual pregnancy.