腹腔镜在子宫瘢痕妊娠中的应用  

Laparoscopic Surgery in Treatment of the Cesarean Scar Pregnancy

作　　者：赵绍杰[1] 罗小平[1] 杨炜敏[1] 

机构地区：[1]南京医科大学附属无锡妇幼保健院妇科,江苏省无锡市214000

出　　处：《国际妇产科学杂志》2014年第5期505-508,521,共5页Journal of International Obstetrics and Gynecology

摘　　要：随着剖宫产的增加,剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)的发生率随着增加。其发生是因为剖宫产时子宫下段瘢痕愈合不良所致,随着经阴道超声诊断准确性的不断提高,目前CSP的诊断已不是临床难题。但在治疗方案选择上国际尚无统一标准,因为子宫CSP患者病情及就诊时情况面临的个体差异非常大,方案选择应当个体化,而个体化方案的选择缺乏规范化标准,是临床面临的主要难题。当前普遍认为,对于有手术指征者,尽早手术既可去除病灶,避免发生子宫破裂、大出血等危及生命的并发症甚至切除子宫而丧失生育能力,又可修复子宫瘢痕缺陷,降低再次妊娠的风险。腹腔镜在中国已经普及,许多医院都有腹腔镜手术的设备及技术,手术安全性及可行性无需置疑。综述近年腹腔镜在剖宫产术后子宫CSP中应用的相关报道,腹腔镜手术是手术患者的首选治疗措施,可将对患者生活质量的影响降至最低。但手术风险必须充分评估,由技术娴熟的医生主刀操作,术前必须准备好应对出血的措施,必要时转为子宫切除,术中要仔细检查有无膀胱损伤。The incidence rate of cesarean scar pregnancy （CSP） after cesarean section increases rapidly in recent years due to the increase of cesarean delivery. The CSP is caused by poor healing of lower uterine segment of cesarean section scar. Although with the progress in transvaginal ultrasonography, the diagnosis of these conditions is not the challenge for clinical doctor anymore, but the standardized management of CSP is not well established and the patient′s condition with CSP is various when visit the hospital, the treatment must be individualized as well. The main problem we face now is there has no standardized criteria for the selection of individualized treatment. The current opinion is that, for the patients with operation indications, operation can remove lesions as soon as possible could not only avoid life-threatening complications such as uterine rupture, hemorrhage, especially hysterectomy and loss of fertility, but also could repair the uterine scar defects and reduce the risk of CSP again. Laparoscopy had been widely used in China and many hospitals have the appropriate equipments and techniques, it is no doubt for operation safety and feasibility. In this review, we summarized the recent clinical researches about laparoscopic treatment cesarean scar pregnancy. The conclusion is that laparoscopic operation should be the first line treatment of CSP with operation indications, which had the lowest effect on the patient′s life quality after operation. However, there had several points needs to be fully evaluated, the operation should be done by skilled surgeon, always be ready for heavy hemorrhage in the operation and change to hysterectomy anytime necessary, injury of bladder should be carefully checked before the operation ends.

关 键 词：腹腔镜 剖宫产术 瘢痕 妊娠 异位 治疗 

分 类 号：R713.4[医药卫生—妇产科学]