腹腔镜手术治疗外生型剖宫产术后子宫瘢痕妊娠32例临床分析  

Study on laparoscopic surgery in treatment of caesarean scar pregnancy

作　　者：王光伟 刘晓菲[2] 萨日娜[1] 王丹丹[1] 杨清[1] 

机构地区：[1]中国医科大学附属盛京医院妇产科,沈阳110004 [2]沈阳市妇婴医院产科

出　　处：《中华妇产科杂志》2014年第1期6-9,共4页Chinese Journal of Obstetrics and Gynecology

基　　金：辽宁省教育厅科学研究一般项目（L2012291）

摘　　要：目的探讨腹腔镜手术治疗外生型剖宫产术后子宫瘢痕妊娠（CSP）的安全性及可行性。方法回顾性分析2009年1月至2011年5月在中国医科大学附属盛京医院诊治的外生型CSP患者共71例的资料，其中39例行宫腔镜病灶切除术（官腔镜组），32例行腹腔镜病灶剔除术（腹腔镜组），比较两组患者手术时间、术中出血量、术后宫腔引流量、术后住院时间、血清B-hCG降至正常时间等。结果宫腔镜组中2例因病灶外凸明显，术中出血量大，转行开腹病灶切除术，另外37例均顺利完成手术，腹腔镜组手术均顺利完成。宫腔镜组手术时间、血清β-hCG降至正常的时间、术后宫腔引流量及术后住院时间分别为（44±18）min、（27±5）d、（38．4±12）ml、（3．8±0．7）d，腹腔镜组分别为（100±21）min、（17±4）d、（19±6）ml、（3．5±0．6）d，分别比较，差异均有统计学意义（P〈0．05）；但术中出血量宫腔镜组为（113±63）ml，腹腔镜组为（109±59）ml，两组比较，差异无统计学意义（P〉0．05）；病灶吸收时间官腔镜组为（88±17）d，腹腔镜组因病灶已经完全剔除，故不涉及病灶吸收时间。结论腹腔镜CSP病灶剔除术治疗具有出血少、住院时间短、恢复快等优点，同时可修复子宫瘢痕、减少再发风险、保留患者生育能力，尤其适用于治疗外生型CSP。Objective To investigate the safety and feasibility of laparoscopic removal of exogenous caesarean scar pregnancy （CSP）. Methods From January 2009 to May 2011, 71 patients with CSP treated in Shengjing Hospital of China Medical University were studied retrospectively. Thirty-nine patients were treated with hysteroscopic excision of CSP, while 32 patients were treated with laparoseopic surgery. The following clinical parameters were compared, including intraoperative blood loss, quantity of postoperative uterine drainage, postoperative hospital days, the time for the mass absorption and the return of [3-hCG to normal were studied. Results Two cases in the hysteroscopic group were transformed to abdominal surgery because of introperative bloody loss, the 37 cases underwent hysteroscopic surgery successfully with the ultrasound supervision and guidance. Laparoscopie surgery were successfully completed in all 32 cases. In hysteroscopic group, the operation time, the time for the return of serum [3-hCG to normal, postoperative uterine drainage volume and the postoperative hospital stay were （44 ± 18 ） minutes, （27 ± 5 ） days, （38± 12） ml, （3.8 ± O. 7） days. While, in laparoscopic group, they were （100 ±21 ） minutes, （17± 4） days, （19 ＋6）ml, （3.5 ± 0.6 ） days, respectively, the differences reached statistically significant （all P 〈0. 05 ）. But the amount of intraoperative bleeding were was （113 ± 63 ） ml in hysteroscopic group and （ 109 ± 59 ） ml in laparoscopic group, the difference was not statistically significant （ P 〉 0. 05 ）. The duration of absorption of mass were （88 ± 17 ） days in hysteroscopie group. In laparoscopic group, the mass were completely removed. Conclusions Laparoscopic exicion of CSP could be suitable in treatment of exogenous CSP which offers advantages including prompt recovery, blood loss and hospital stays. This management could repair the uterine scars, reduce the reoccurring risk and conservate the fertility potential.

关 键 词：妊娠 异位 腹腔镜检查 剖宫产术 手术后并发症 瘢痕 

分 类 号：R713.4[医药卫生—妇产科学]