宫腔镜及宫腹腔镜联合治疗39例剖宫产瘢痕妊娠的临床分析  

The clinical analysis of laparoscopy and hysteroscopy of ectopic pregnancy in 39 cases with the cesarean scar

作　　者：梅立[1] 岳军[1] 谢兰[1] 

机构地区：[1]四川省医学科学院.四川省人民医院妇产科,四川成都610072

出　　处：《四川医学》2012年第11期1906-1908,共3页Sichuan Medical Journal

摘　　要：目的探讨宫腔镜及宫腹腔镜联合治疗剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)患者的临床疗效。方法回顾性分析我院2006～2011年诊治的CSP患者39例,根据孕囊生长的方向分为内生型(A)组和外生型(B)组,A组23例,B组16例,A组采用宫腔镜下清宫术,配合药物辅助治疗;B组行宫腹腔镜联合妊娠病灶切除+子宫瘢痕修补术,配合药物辅助治疗。结果治疗/后两组血hCG值的差异无统计学意义(P>0.05),而B组血HCG恢复正常的时间较A组短,差异有统计学意义(P<0.05)。结论对于CSP患者,采用积极手术干预配合药物治疗的方法,治疗周期短,效果确切,有利于提高患者生活质量。术前如充分分析患者病情,明确诊断及CSP类型,均能采用不同的保留子宫的保守性手术治疗。Objective The feasibility and outcome of laparoscopy and hysteroscopy for patients with ectopic pregnancy in the cesarean section scar was studied.Methods From January 2006 to December 2011,39 patients diagnosed with ectopic pregnancy in a previous cesarean section scar underwent laparoscopic or hysteroscopic removal of the gestational sac at our department.All the cases were divided into two types: A and B.A retrospective review of medical records of these patients was performed.Results In all of them,the ectopic gestational sacs of type I were removed by hysteroscopy,those of type II were removed by hysteroscopy and laparoscopy without converting to laparoctomy and the scar defect was repaired by intracorporeal sutures.All the cases had a steady decline of the serum β-hCG level.The lasting time of the serum β-hCG level in Type B was shorter than that in Type A(P<0.05) 。All the patients required additional methotrexate administration postoperatively.Conclusion Hysteroscopic/Laparoscopic and hysteroscopic removal of ectopic gestational sac within a cesarean scar seems to be a feasible and safe procedure that might be considered as a treatment option.

关 键 词：子宫瘢痕部位妊娠 宫腹腔镜手术治疗 

分 类 号：R713[医药卫生—妇产科学]