腹腔镜下妊娠病灶切除术治疗Ⅱ型及Ⅲ型剖宫产瘢痕部位妊娠的疗效分析

The curative effect of laparoscopic scar pregnancy leision resection in the treatment of typeⅡand typeⅢcesarean scar pregnancy

目的探讨腹腔镜下妊娠病灶切除术治疗Ⅱ型及Ⅲ型剖宫产瘢痕部位妊娠(CSP)的应用价值。方法对中山市人民医院2018年11月至2020年8月采用腹腔镜下妊娠病灶切除术治疗的39例剖宫产瘢痕部位妊娠进行回顾性分析。患者停经时间为(50.1±8.4)d,妊娠包块平均直径为(27.2±7.5)mm,血hCG为(12055.0±7912.9)mIU/mL。其中Ⅱ型28例,Ⅲ型11例,23例可探及心管搏动。术前均未使用甲氨蝶呤等药物治疗。结果39例患者均手术成功,手术时间(62.3±7.2)min,术中出血(138.3±202.9)mL。除2例因术中出血多而行输血治疗外,无其他手术并发症。术后住院时间为(3.3±1.1)d,阴道出血时间为(4.8±1.2)d,血hCG降至正常时间为(19.6±2.6)d,月经复潮时间为(35.0±4.5)d。术后无辅助药物等其他治疗,无宫腔粘连等并发症。结论腹腔镜下妊娠病灶切除术是一种治疗剖宫产瘢痕部位妊娠的有效方法,具有微创、并发症少及高效等优点。

Objective To explore the curative effect of laparoscopic scar pregnancy leision resection in the treatment of typeⅡand typeⅢcesarean scar pregnancy(CSP).Methods A retrospective analysis was conducted on 39 cases of CSP treated with laparoscopic scar pregnancy leision resection in Zhongshan City People’s Hospital from November 2018 to August 2020.The patients’menopause time was(50.1±8.4)days,the average diameter of pregnancy mass was(27.2±7.5)mm,and the blood hCG was(12055.0±7912.9)mIU/mL.Among them,28 cases were typeⅡ,11 cases were typeⅢ,and 23 cases had detectable heart beats.No medications such as methotrexate were used before operation.Results All 39 patients were successfully operated.The operation time was(62.3±7.2)min,and the intraoperative blood loss was(138.3±202.9)mL.Except for 2 patients who received blood transfusion due to excessive intraoperative bleeding,there were no other surgical complications.Postoperative hospital stay was(3.3±1.1)d,vaginal bleeding time was(4.8±1.2)d,blood hCG decreased to normal time was(19.6±2.6)days,menstrual recovery time was(35.0±4.5)d.There was no other adjuvant treatments,and no complications such as intrauterine adhesions.Conclusions Laparoscopic scar pregnancy leision resection is an effective method for the treatment of CSP,with the advantages of minimal invasiveness,fewer complications,and high efficiency.