腹腔镜双侧子宫动脉阻断联合宫腔镜妊娠病灶清除治疗剖宫产瘢痕妊娠  

Laparoscopic Bilateral Uterine Artery Occlusion Combined with Hysteroscopic Resection in the Treatment of Cesarean Scar Pregnancy

作　　者：李英 张坤[2] 韩劲松[2] 姚颖[2] 杨俊芳[2] 陈永康[2] 郭红燕[2] 赵扬玉[2] 种轶文[2] 

机构地区：[1]秦皇岛军工医院妇产科,秦皇岛066000 [2]北京大学第三医院妇产科,北京100083

出　　处：《中国微创外科杂志》2017年第3期216-219,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市科学技术委员会凶险型胎盘植入诊断技术及治疗效果研究(项目编号:63520-04)

摘　　要：目的探讨腹腔镜双侧子宫动脉阻断联合宫腔镜妊娠病灶清除治疗剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的疗效。方法 2013年1月~2015年5月北京大学第三医院妇科诊治62例CSP,均行经阴道超声检查进行初筛,盆腔MRI确诊,腹腔镜下先分离出双侧子宫动脉并进行阻断,然后在宫腔镜下清除剖宫产瘢痕部位的妊娠病灶,复查术后血h CG、妇科超声,评估治疗效果。结果 62例均成功实施腹腔镜下双侧子宫动脉阻断及宫腔镜妊娠病灶清除,无中转开腹及子宫切除。术中出血量中位数为30 ml(P_(25):20 ml,P_(75):100 ml),4例因病灶范围大,术中出血分别为600、600、800、800 ml,其中3例输血。1例因术后h CG下降不满意再次行宫腔镜妊娠病灶清除术。血h CG术后4~75 d,(30.9±16.9)d降至正常。术后20~75 d,(34.8±11.4)d月经恢复来潮。62例随访4~32个月,(15.8±8.0)月,5例再次妊娠,其中4例足月剖宫产分娩,1例术后再次发生CSP,行宫腔镜病灶清除。结论腹腔镜双侧子宫动脉阻断联合宫腔镜瘢痕妊娠病灶清除治疗CSP疗效确切,是治疗CSP的理想方法。Objective To investigate the value of laparoscopic bilateral uterine artery occlusion combined with hysteroscopic resection in the treatment of cesarean scar pregnancy（ CSP）. Methods A total of 62 patients with CSP were admitted to this hospital from January 2013 to May 2015. Transvaginal ultrasound was performed for primary screening,and pelvic MRI for diagnosis.Uterine arteries were separated and coagulated during laparoscopic surgery,followed by hysteroscopic surgery. The postoperative serum h CG level tests and ultrasonography examinations were conducted for evaluating the surgical outcomes. Results The procedure was successfully completed under laparoscopy and hysteroscopy without surgical complications or conversions to open surgery in all the cases. The median blood loss was 30 ml（ P25： 20 ml,P75： 100 ml）. In 4 patients the intraoperative bleeding reached 600,600,800,and 800 ml,respectively,due to large lesions,with blood transfusions requirement in 3 patients. One patient received secondary hysteroscopy due to unsatisfied h CG decrease. The serum h CG levels dropped to normal in 4-75 d（ 30. 9 ± 16. 9 d） after operation.The menstuation cycles recovered to normal in 20-75 d（ 34. 8 ± 11. 4 d）. During follow-ups for 4-32 months（ 15. 8 ± 8. 0 months）in 62 cases,5 patients had subsequent pregnancy,4 of which had full-term pregnancy and 1 of which experienced CSP again and received hysteroscopic removal of pregnancy. Conclusion Laparoscopic bilateral uterine artery coagulation and hysteroscopic removal of pregnancy is an ideal choice for the treatment of CSP with good outcomes.

关 键 词：腹腔镜 宫腔镜 子宫动脉阻断 剖宫产瘢痕妊娠 

分 类 号：R713.8[医药卫生—妇产科学]