经阴道手术治疗剖宫产瘢痕妊娠失败的经验分析  

A Study on Failed Transvaginal Removal of Ectopic Pregnancy Tissue in the Treatment of Cesarean Scar Pregnancy

作　　者：肖水秀 单莉莉[1] 乐爱文[1] 肖天慧[1] 卓蓉[1] 王中海[1] 

机构地区：[1]广东医学院附属深圳南山医院妇科,深圳518052

出　　处：《中国微创外科杂志》2016年第5期432-435,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的总结经阴道手术治疗剖宫产瘢痕妊娠（cesarean scar pregnancy,CSP）失败的经验。方法 2011年3月~2015年4月,采用经阴道子宫下段切开取胚＋子宫缺陷修补术治疗CSP 98例,其中9例治疗失败。4例改行子宫动脉栓塞＋清宫术,2例中转腹腔镜手术,1例中转开腹手术,1例改行病灶抽吸术局部注射甲氨蝶呤（MTX）,1例术后血β-h CG下降缓慢,肌注MTX治疗。结果 9例均病灶清除,保留子宫,术后1个月内血β-h CG降至正常,30~50 d[（40.1±7.2）d]月经复潮。结论阴式手术适用于阴道宫颈暴露良好、包块〈4 cm的外生型CSP,术前全面评估,备好相关预案,可以避免因盲目手术造成的损失,提高阴式手术治疗CSP的成功率。Objective To study lessons of failed transvaginal removal of ectopic pregnancy tissue in the treatment of caesarean scar pregnancy（ CSP）. Methods A total of 98 patients with CSP were enrolled from March 2011 to April 2015. The surgery was failed in 9 cases. There were 4 cases of conversion to uterine artery embolization,2 cases of conversion to laparoscopic surgery,1 case of conversion to open surgery,1 case of conversion to aspiration with local injection of MTX,and 1 case of postoperative injection of MTX intramuscularly due to a slow drop of serum β-h CG. Results The lesions were all cleared,and patients＇ uterus were preserved. The serum β-h CG levels of all the patients became normal within 1 month after the treatment. The time of re-menstruation was（ 40. 1 ± 7. 2） days（ range,30- 50 days）. Conclusions Vaginal surgery is suitable for exogenous type of CSP with good exposure of the vagina and cervix and the cystic mass〈 4 cm. By comprehensive evaluation before the surgery and preparing alternative plans,we can avoid losses from blind surgery and increase the successful rate of vaginal surgery in cesarean section scar pregnancy.

关 键 词：剖宫产瘢痕妊娠 经阴道手术 

分 类 号：R714.22[医药卫生—妇产科学]